以单纯蛋白尿为主要表现IgA肾病患者的临床与病理分析

Clinical and pathological characteristics of IgA nephropathy patient with proteinuria

目的分析以单纯蛋白尿为主要表现的IgA肾病的临床与病理特点,并进行相关性分析。方法回顾性分析79例以单纯蛋白尿为主要表现的IgA肾病患者的临床和病理资料,采用Spearman相关分析方法进行病理损伤和免疫球蛋白沉积类型与病理分级的相关分析。结果按Lee氏分级,II级28例(35.44%),III级37例(46.84%),IV级14例(17.72%),Katafuchi积分与血尿酸、血肌酐、平均动脉压呈正相关,与尿蛋白、总胆固醇、甘油三酯无相关性。免疫病理分型:IgA型8例(10.13%),IgA+C3型8例(10.13%),IgA+IgM型14例(17.72%),IgA+IgM+C3型46例(58.23%),IgA+IgG+IgM+C3型3例(3.8%),以IgA+IgM+C3型多见。结论单纯蛋白尿IgA肾病患者病理损伤均较重,以III～IV级为主,免疫球蛋白沉积类型以IgA+IgM+C3多见。

Objective To analyze clinical and pathological characteristics of 79 IgA nephropathy patient with proteinuria. Methods The detailed clinicopathologic data of 79 IgA nephropathy patients with proteinuria were retrospectively analyzed, and the relation- ship between renal pathologic lesions and clinical factors were studied. Results According pathological degree constituted by Lee＇s classification： 28 cases （35.44%） were grade Ⅱ, 37 cases（46.84% ） were grade Ⅲ, 14 cases （17.72%） were grade Ⅳ, respectively. There were no cases of grade Ⅰ and Ⅴ in this study, and score for each patient was evaluated according to Katafuchi pathological scoring method. The correla- tion analysis indicated the Katafuchi pathological score was positively associated with serum creatinine, mean arterial pressure, uric acid re- spectively, no associated with urine protein, serum total cholesterol and serum triglyceride respectively. Immunofluorescence type： IgA 8 cases （ 10. 13% ）, IgA ＋ C3 8 cases （ 10.13% ）, IgA ＋ IgM 14 cases （ 17.72% ）, IgA ＋ IgM ＋ C3 46 eases （58.23%）, IgA ＋ IgG ＋ IgM ＋ C3 3 cases （3.8%）, IgA ＋ IgM ＋ C3 was very contain. Conclusion Patients with IgA nephropathy with proteinuria in this study presented with more serious renal injury features. Renal biopsy is very useful for prognosis of IgA nephropathy.