IgA肾病高尿酸血症与牛津病理分型及临床特征

Clinical characteristics and Oxford classification of IgA nephropathy patients with hyperuricemia

目的探讨IgA肾病高尿酸血症与肾脏病理牛津分型、组织病理学及临床特征的关系。方法收集151例IgA肾病,将其分为血尿酸升高组与血尿酸正常组,对肾脏病理切片进行牛津分型、Lee氏分级和肾小球硬化、新月体及血管病变分析,并记录一般资料、血压、肾功能、尿蛋白等临床指标。结果 151例中IgA肾病,高尿酸血症的发病率为48.3%,青壮年男性易发,高血压与高尿酸血症密切相关。肾脏病理牛津分型主要表现为M1E0S1T0,Lee氏分级主要表现为Ⅲ级,伴高尿酸血症患者肾脏病理突出表现为肾小管间质慢性化病变重,肾小球硬化比例增多,伴有肾小球滤过率下降,而血管病变差异不明显。结论 IgA肾病伴高尿酸血症发病率高,牛津分型显示伴有高尿酸血症的IgA肾病其肾小管间质慢性病变更明显,伴有肾小球滤过率下降,临床表现更重。

Purpose To investigate the clinical characteristics and Oxford classification of IgA nephropathy patients with hyperuricemia. Methods 151 IgA nephropathy patients confirmed by renal biopsy in 2013 were analyzed retrospectively. The patients were divided into the two groups： IgA nephropathy patients with or without hyperuricemia. Morphological changes were evaluated with Oxford classification scoring system and Lee＇s grades. A comparative analysis of clinical manifestations and pathological injuries was performed between the two groups. Results Incidence of hyperuricemia in IgA nephropathy patients was 48. 3% and was more common in young men. Hypertension was associated with hyperuricemia. Oxford classification of IgA nephropathy patients with hyperuricemia was predominant M1E0S1T0 and Lee＇s grades presented with grade Ⅲ. The outstanding histopathologic features with higher plasma uric acid levels indicated higher tubulointerstitial chronicity,higher glomerular sclerosis ratio,accompanied by a decline in glomerular filtration rate. There was no significant difference of vascular lesions. Conclusions The prevalence of hyperuricemia in IgA nephropathy patients is high. Oxford classification shows IgA nephropathy with hyperuricemia are associated with more severe tubulointerstitial lesions and lower GFR.