IgA肾病预后不良因素与肾血管病变相关性分析

Correlation of risk factors for poor prognosis in IgA nephropathy with renal vascular lesions：report of 100 cases

目的：探讨IgA肾病（IgAN）肾血管病变的危险因素。方法选择宁夏人民医院肾脏内科2010年10月至2013年7月经肾活检确诊的原发性IgAN患者100例，并将其分为肾血管病变组和无肾血管病变组，进行对照研究，比较肾血管病变与各项临床指标、病理改变之间的关系。结果100例IgAN患者中有肾血管病变者70例（70%），无肾血管病变者30例（30%）。单因素分析结果表明，肾血管病变组24h尿蛋白、血尿酸、血肌酐均高于无肾血管病变组（P＜0.05），血清白蛋白低于无肾血管病变组（P＜0.05）；病理学检查显示肾小球硬化、肾间质纤维化、新月体形成、炎性细胞浸润、肾小管萎缩严重病理表现发生率，肾血管病变组明显高于无肾血管病变组（P＜0.05）。多因素非条件logistic回归分析结果表明，高血压（OR＝7.728，95%CI 1.708～34.964）、24h尿蛋白定量（OR＝20.022，95%CI 3.869～103.623）、肾小球硬化（OR＝12.093，95%CI 2.431～60.149）、肾间质纤维化（OR＝8.511，95%CI 1.332～54.396）是IgAN肾血管病变加重的危险因素。结论 IgAN预后不良因素为高血压、24h尿蛋白定量、肾小球硬化、肾间质纤维化，上述指标与IgAN肾血管病变密切相关，进一步证实了肾血管病变可作为判断预后的一项重要病理指标。

Objective To investigate the risk factors of renal vascular lesions （RVLs） in IgA nephropathy （IgAN）. Methods A total of 100 patients with primary IgAN diagnosed by renal biopsy admitted in Department of Nephrology, Ningxia People’s Hospital from October 2010 to July 2013 were subjected in this study. They were divided into 2 groups： the RVLs group and non-RVLs group. The data of clinical and pathological features in 2 groups were compared and analyzed. Results There were 70 patients （70%） in RVLs group, and 30 （30%） in non-RVLs group. Compared to non-RVLs group, the RVLs group had significantly higher 24-hour urine protein, serum uric acids and serum creatinine （P〈0.05）, and obviously lower serum albumin （P〈0.05）. Pathological observation indicated that the incidences of glomerular sclerosis, interstitial fibrosis, crescent, interstitial infiltrate, and tubular atrophy were significantly higher in RVLs group than in non-RVLs group （P〈0.05）. Multivariate unconditional logistic regression analysis showed that hypertension （OR=7.728, 95%CI 1.708-34.964）, 24-hour urine protein （OR=20.022, 95% CI 3.869-103.623）, glomerulosclerosis （OR=12.093, 95%CI 2.431-60.149）, and renal interstitial fibrosis （OR=8.511, 95%CI 1.332-54.396） were the factors aggravating RVLs in IgAN patients. Conclusion Hypertension, 24-hour urine protein, glomerulosclerosis and renal interstitial fibrosis are risk factors for poor prognosis of IgAN, and they are closely associated with RVLs. The results indicate that RVLs can be regarded as an important pathological prognostic indicator.