102例IgA肾病的临床与病理分析

IgA Nephropathy: A Clinical and Pathologic Analysis of 102 Cases

目的探讨102例原发性IgA肾病患者的临床与病理的特点及其相关性。方法回顾性分析102例经肾活检病理确诊为原发性IgA肾病患者的临床及病理资料。结果原发性IgA肾病患者占同期肾活检患者总数的36.16%,男女发病比例1∶1.27,发病年龄(31.93±10.93)岁,平均病程3(11)个月,发病高峰年龄段20～40岁。IgA肾病患者在临床分型中以尿检异常型(U-ab)最多见,约占38.24%。病理Haas分级中主要为Ⅲ级局灶增生性肾小球病变,约为43.14%。高血脂、高血压和IgA肾病患者肾脏病理损伤程度有关(P<0.05)。病理Haas分级和24 h尿蛋白定量没有明显的相关性(Spearman相关系数=0.12,P=0.19>0.05)。结论 IgA肾病的临床、病理具有多样性,有一定相关性但不平行,有必要定期尿检及结合临床表现早期行肾活检以明确肾脏病理诊断。

Objective To analyze the clinicopathological characteristics of 102 patients with primary IgA nephropathy,and to investigate the correlation between clinical features and pathological findings.Methods A retrospective analysis was performed to investigate the clinical and pathological features of 102 patients with primary IgA nephropathy confirmed by renal biopsy.Results Patients with primary IgA nephropathy accounted for 36.16% of patients undergoing renal biopsy during the same period and the male-to-female incidence ratio was 1∶1.27.The average age of onset was（31.93 ±10.93） years and the incidence peak appeared among patients aged 20-40.The average course of disease was 3（11） months.The presence of abnormal urinalysis（U-ab） was the most common in patients with IgA nephropathy,accounting for 38.24% of the total cases.According to Haas classification,grade III focal hyperplastic glomerular lesions were the most common pathological findings in patients with IgA nephropathy,accounting for 43.14% of the total cases.Moreover,the degree of renal injury was correlated with hyperlipemia and hypertension in patients with IgA nephropathy（P〈0.05）.However,there was no correlation between Haas classification and 24 hour urine protein excretion（Spearman r= 0.12;P =0.19）.Conclusion IgA nephropathy has diverse clinicopathological manifestations.The clinical features are correlated with pathological characteristics,but they are not parallel.Periodic urinalysis and early renal biopsy are necessary for definite diagnosis of kidney injury.