IgA肾病与系膜增生性肾小球肾炎临床特征对比分析

Comparison of Clinical Features between IgA Nephropathy and Mesangial Proliferative Glomerulonephritis

目的了解IgA肾病与系膜增生性肾小球肾炎(MsPGN)的流行病学特点,对比两者的临床表现,为这两种疾病的诊断和鉴别诊断提供依据。方法收集1990年6月—2010年6月在我院经肾活检病理检查确诊且资料较完整的IgA肾病(IgA肾病组)及MsPGN(MsPGN组)患者的临床资料,回顾性分析两组患者的临床表现、实验室检查指标及临床表现类型等并进行比较。结果 (1)两组患者的性别构成间差异无统计学意义(P>0.05),均以男性多见;IgA肾病组的年龄较MsPGN组小,差异有统计学意义(P=0.000)。(2)临床表现:IgA肾病组水肿、胆固醇升高、血中IgG降低的发生率低于MsPGN组,而血尿、血压升高、血中IgA升高的发生率高于MsPGN组,差异均有统计学意义(P=0.000)。(3)IgA肾病组的尿蛋白定量、血中C3水平低于MsPGN组,而血浆清蛋白、血中IgA水平及血中IgA/C3比值高于MsPGN组,差异均有统计学意义(P=0.000)。(4)两组患者的临床表现类型比较差异有统计学意义(P=0.000)。结论 (1)两种疾病均以中青年男性多见,IgA肾病患者的年龄较轻。(2)IgA肾病患者易发生血尿、高血压、血中IgA升高,而MsPGN患者易发生水肿;IgA肾病以慢性肾炎常见,而MsPGN以肾病综合征为主。(3)两组患者的尿蛋白水平均与血浆清蛋白、IgG水平呈负相关,而与胆固醇水平呈正相关。(4)血中IgA水平及血中IgA/C3比值对IgA肾病的诊断有一定帮助。

Objective To understand the epidemiology of IgA nephropathy and mesangial proliferative glomerulone phritis （MsPGN） and compare their chnical features. Methods The chnical data of the patients with IgA nephropathy or MsPGN confirmed by renal biopsy from June 1990 to June 2010 were collected and analyzed retrospectively. Results The gender constituent ratio showed no significant difference between these two groups （P 〉 0.05）, with more males in the IgA nephropathy group. The age of patients in the IgA nephropathy group was significantly younger than in the MsPGN group （ P = 0. 000）. Also, the IgA nephropathy group had significantly lower incidence of edema, elevated cholesterol, and reduced IgG and higher inci dence of hematuria, elevated blood pressure, and elevated IgA （ P = 0. 000）. The urine protein levels were negatively correlated with serum albumin and IgG levels and positively with cholesterol in both two groups （P = 0. 000）. Conclusion Both lgA ne phropathy and MsPGN are more likely to occur in young and middle aged men. They share some clinical manifestations and also have certain differences. Blood IgA level and IgA / C3 ratio are helpful for the diagnosis of IgA nephropathy.