不同年龄段IgA肾病患者的肾脏病理特征性变化分析

Analysis of renal pathological characteristic changes in the different age groups of patients with IgA nephropathy

目的 通过对不同年龄段IgA肾病患者的肾脏病理分析,探讨肾脏病理改变在不同年龄阶段是否存在特征性改变.方法 原发性IgA肾病149例按患者年龄分为4组（A组0～20岁,B组21～40岁,C组41～60岁,D组60岁以上）,参考Katafuchi IgA肾病积分标准和牛津分类标准对其肾脏病理改变与免疫荧光特点进行分析研究.结果 两种方法显示结果基本一致,肾组织病理改变积分以A组最低,积分均从A组、B组、C组逐渐增加.A组IgA荧光强度显著高于C组和D组（P＜0.05）;D组IgM荧光强度明显低于A组（P＜0.05）.结论 即IgA肾病的病理改变与年龄有相关性,60岁前随着年龄增长肾脏损伤程度逐渐加重.20岁以下IgA肾病患者,免疫物质沉积强度强,推测免疫因素可能参与肾损伤的作用大且程度重,但病理改变最轻,可能预后最好.

Objective To explore the renal pathological characteristic changes in the different age groups of patients with IgA nephropathy. Methods According to age, 149 cases of primary IgA nephropathy were randomized into 4 groups （A group for 0 to 20 years old,B group for 21 to 40 years old, C group for 41 to 60 years old, D group beyond 60 years old）. The renal pathological changes and immune fluorescence characteristics were compared by Katafuehi reference standard and Oxford classification standard of IgA nephropathy. Results The two methods showed the similar results. The scores of renal histopathologic changes in group A were lowest, followed by group B, and group C. Immune fluorescence intensity of IgA in group A was significantly stronger than that in groups C and D （P〈0. 05）, and immune fluorescence intensity of IgM in group D was obviously weaker than that in group A （P〈0. 05）. Conclusions The pathological changes of the IgA nephropathy has a correlation with age. With the age increasing, the kidney injury is aggravated gradually （60 years ago）. The immune factors play roles in the renal injury of IgA nephropathy patients under the age of 20 largely and heavily, but the renal pathological changes are mild, and the prognosis may be best.