伴血脂异常的IgA肾病的临床及病理特征

Clinical and pathological features in IgA nephropathy with lipid disorders

目的探讨IgA肾病中不同类型的血脂异常与高血压、蛋白尿、估算的肾小球滤过率（eGFR）等临床资料及肾脏病理的关系。方法本研究为回顾性分析，共纳入了264例经肾活检确诊的IgA肾病患者。记录活检前血压、24h尿蛋白定量、eGFR、血脂等临床资料及活检后病理资料。分别比较伴不同血脂异常类型的IgA肾病的临床及病理特征。结果IrA肾病伴高胆固醇血症者较胆固醇正常者更易于合并高血压（43．5％w．25．7％，P=0．015），eGFR[（62．56±21．00）ml·min^-1·（1．73m^2）^-1vs．（74．76±19．20）ml·min^-1·（1．73m2）^-1，P〈0．001]及血白蛋白水平[（34．12±9．22）g／L vs．（40．74±3．27）g／L，P〈0．001]更低，24h尿蛋白量[1．57（0．47～3．84）g／24h vs．0．28（O．11-0．70）g／24h，P〈0．001]更多。而IgA肾病合并高甘油三酯血症者则较甘油三酯正常者更容易倾向为男性（46．3％VS．29．5％，P=-0．019），年龄更大[（38．6±12．3）岁VS．（34.3±11．9）岁，P=O．017]，也易发生高血压（46．3％坩．24．3％，P=0．001），24h尿蛋白量f0．69（0.26～2．16）g／24h VS．0．30（0．11-0．77）g／24h，P=0．001]亦更大，并易发生肾间质纤维化（70．4％ vs．45．7％，P=0．001）及肾小动脉病变（31．5％ vs 18．6％，P=0．038）。血脂异常与肾脏病理Hass分级无明显相关性。结论高胆固醇血症与高甘油三酯血症加重IgA肾病的临床指标。而且，高甘油三酯血症是IgA肾病发生肾间质纤维化及肾小动脉病变的危险因素。

Objective To investigate the association between lipid disorders and the clinical and pathological features in patients with IgA nephropathy （IgAN）. Methods A total of 264 patients with biopsy-proven IgAN were enrolled. Clinical data such as blood pressure, 24-hour urine protein amount, eGFR and blood lipid level were recorded before biopsy and pathological data were recorded after biopsy. We tried to identify the clinical and pathological features of IgAN with different types of lipid disorders. Results Compared to the IgAN patients with normal cholesterol, those with hypercholesteremia had a significantly higher prevalence of hypertension （43.5% vs. 25.7%, P=0.O15）, lower level of eGFR [（62.56±21.00）ml · min^-1 （1.73 m^2）^-1 vs. （74.76±19.20）ml · min^-1 （1.73 m^2）^-1, P〈O.O01] and albumin [（34.12±9.22）g/L vs. （40.74±3.27）g/L, P〈0.001], and higher level of 24-hour urine protein amount [1.57（0.47-3.84）g/24 h vs. 0.28 （0.11-0.70）g/24 h, P〈0.001]. It revealed significantly more male （46.3% vs. 29.5%, P=0.019）, older age [（38.6±12.3）years vs. （34.3±ll.9）years, P=0.017], higher prevalence of hypertension （46.3% vs. 24.3%, P=0.O01） and higher level of 24-hoar urine protein amount [0.69（0.26±2.16）g/24 h vs. 0.30 （0.11-0.77）g/24 h, P=0.001] ha hypertriglyceridaemia group. Meanwhile they were more likely to develop renal interstitial fibrosis （70.4% vs. 45.7%, P=0.001） and renal arteriolar lesion （31.5% vs. 18.6%, P00.038）. There was no relationship between lipid disorders and Hass degree. Conclusions Both hypercholesteremia and hypertriglyceridemia together are worse to the clinical parameters of IgAN. Moreover, hypertriglyceridaemia is a risk factor of renal interstitial fibrosis and renal artcriolar lesion in IgAN patients.