高尿酸血症与IgA肾病临床和病理表现的关系

Correlation between hyperuricemia and clinicopathologic features of patients with IgA nephropathy

目的分析IgA肾病合并高尿酸血症患者的临床和病理特征。方法将228例IgA肾病患者分为血尿酸正常组（154例）和高尿酸血症组（74例），回顾性分析2组患者的年龄、血尿酸、估算肾小球滤过率（eGFR）、24h尿蛋白定量、总胆固醇（Tc）、血白蛋白（Alb）以及肾脏病理改变的差异。结果与血尿酸正常组相比，高尿酸血症组的尿蛋白明显增多（P〈0．01），eGFR显著降低（P〈0．01），肾小球球性硬化比率显著升高（P〈0．05），肾小球细胞增殖程度和。肾小管间质损伤程度显著加重（P〈0．0B），肾内动脉病变的发生率显著增高（P〈0．05）。Spearman相关分析显示，eGFR与肾小球硬化的比例呈负相关（r=-0．308、P〈0．01）、与肾小球细胞增殖程度呈负相关（r=-0．170，P〈0．01）、与肾小管间质受损的程度呈负相关（r=-0．409，P〈0．01）；而血尿酸与肾小球硬化的比例呈正相关（r=0．147，P〈0．05）、与。肾小球细胞增殖程度呈正相关（r=0．193，P〈0．01）、与肾小管间质受损的程度呈正相关（r=0．219，P〈0．01）；24h尿蛋白定量与肾小球细胞增殖程度呈正相关（r=0．259，P〈0．01）、与肾小管间质受损的程度呈正相关（r=0．225，P〈0．01）。结论高尿酸血症与IgA肾病患者的临床和病理损害相关。

Objective To analyze the clinicopathological features of the patients with IgA ne- phropathy plus hyperuricemia. Methods 228 patients with IgA nephropathy diagnosed by renal biopsy were classified into two groups.. IgA nephropathy with non-hyperuricemia （154 cases） and IgA ne- phropathy with hyperuricemia （74 cases）. Age, blood uric acid, glomerular filtration rate, urine total protein, total cholesterol, serum albumin and renal pathological changes were analyzed retrospectively. Results Compared to non-hyperuricemia group, urinary protein was increased, eGFR decreased, the glomerulus and tubulointerstitial lesions worsened, and the rate of renal small artery-arteriole lesions increased changes in hyperuricemia group. Spearman correlation analysis revealed that the rate of glo- merular sclerosis, the degree of glomerulus cell proliferation and the degree of tubulointerstitial lesions were negatively correlated with eGFR （r=- 0. 308, - 0. 170 and - 0. 409 respectively,P〈0. 01）, but the rate of glomerular sclerosis, the degree of glomerulus cell proliferation and the degree of tubuloint- erstitial lesions were positively with blood uric acid （r = 0. 147, 0. 193 and 0. 219 respectively, P〈0. 01）. The degree of glomerulus cell proliferation and the degree of tubulointerstitial lesions were posi- tively with urine total protein （r = 0. 259 and 0. 225 respectively,P;0. 01）. Conclusions Clinical se- verity and pathological damages in the patients with IgA nepropathy are related with hyperuricemia