277例IgA肾病患者病理分型与临床特点分析

Pathological classification and clinical manifestations of 277 patients with Ig A nephropathy

目的总结分析不同Ig A肾病病理分型及临床表现。方法回顾性分析2010年1月至2014年7月本院收治的277例Ig A肾病患者的临床资料,均接受肾脏病理检查,分析病理分型与各临床指标间的关系。结果轻度系膜增生性Ig A肾病、中度系膜增生性Ig A肾病、局灶增生性Ig A肾病伴缺血性肾损伤、局灶增生硬化性Ig A肾病伴部分新月体形成、局灶增生性Ig A肾病伴急性肾小管损伤、局灶增生性Ig A肾病伴部分肾小球硬化、局灶增生性Ig A肾病分别占11.91%、0.36%、3.61%、0.72%、3.61%、4.33%、63.54%,后五种分型Ig A肾病患者血肌酐水平明显高于前两种分型;不同病理分型Ig A肾病患者24小时尿蛋白定量比较无显著差异。结论不同病理分型Ig A肾病临床表现差异较明显,及时行肾穿刺活检对早期治疗具有重要的指导意义,值得临床推广。

Objective To summarize different pathologic classification and clinical manifestations of Ig A nephropathy. Method A retrospective analysis of 277 patients with Ig A nephropathy in our hospital from January 2010 to July 2014, all of these patients had taken kidney pathologic examination, the pathologic classification and the relationship among various clinical indexes were analyzed. Result Mild mesangial proliferative Ig A nephropathy, moderate mesangial proliferative Ig A nephropathy, focal proliferative Ig A nephropathy with ischemic renal injury, focal hyperplasia sclerosing Ig A nephropathy with partial crescent formation, focal proliferative Ig A nephropathy with acute renal tubular injury, focal proliferative Ig A nephropathy with partial glomerular sclerosis, focal proliferative Ig A nephropathy respectively accounted for 11.91%, 0.36%, 3.61%, 0.72%, 3.61%, 4.33%, 63.54%; the serum creatinine levels of the last five classifications was significantly higher than that of the first two and the difference of 24 h urinary protein level was not statistically significant among different pathological classification. Conclusion Clinical differences among different pathologic classification of Ig A nephropathy are obvious. Getting renopuncture biopsy in time has an important guiding significance in the early treatment and deserve to be expanded clinically.