IgA肾病尿沉渣表现与肾脏病理改变的相关性

Correlations of urinary sediment features with renal pathological manifestations in Ig A nephropathy

目的观察Ig A肾病患者尿沉渣表现与临床表现、肾脏病理改变的相关性。方法采用前瞻性横断面观察性研究。病例来自2013年1月至2015年6月中日友好医院肾内科住院的365例Ig A肾病患者。根据尿沉渣中红细胞和病理管型数量分为4组。根据临床表现分为3组。根据肾脏病理活动与否分为肾小球有明显活动性病变组和无明显活动性病变组。对尿沉渣表现与临床表现、肾脏病理活动进行相关性分析。结果病理类型以局灶增生型最多见,共302例(82.7%),其次为轻度系膜增生型32例(8.8%)等;不同临床表现分组的尿沉渣表现不同(P=0.013);肾脏病理活动组与非活动组的尿沉渣表现的差异有统计学意义(P<0.01)。多因素分析显示,尿沉渣表现是肾脏病理活动与否的危险因素(P<0.01)。结论尿沉渣表现可以部分反映Ig A肾病患者临床表现及肾脏病理的活动性。

Objective To investigate the correlations of urinary sediment features with clinical manifestations and renal pathological changes in IgA nephropathy. Methods In this prospective study, 365 patients with IgA nephropathy from Department of Nephrology, China-Japan Friendship Hospital during January 2013 and June 2015 were enrolled. The patients were divided into 4 groups according to the numbers of urinary red blood cells and pathological cast in urinary sediments, and 3 groups to the clinical manifestations. The pathological patterns of IgA nephropathy included the active lesions group and the inactive lesions group. Then, the correlations of uri- nary sediment features with clinical manifestations and renal pathological changes were analyzed. Results The most common patholog- ical pattern in 365 patients with IgA nephropathy was focal proliferative pattern （302/365, 82.7% ） , and the next was mild mesangial proliferative pattern （32/365, 8.8% ）. There were different urinary sediment features in the patients with different clinical manifesta- tions （P = 0.013 ） and between the active lesions group and the inactive lesions group （P 〈 0.01 ）. Multivariate analysis showed that the change of urinary sediments was the risk factor predicting the active lesions of IgA nephropathy （ P 〈 0.01 ）. Conclusion Urinary sediment features may partly reflect the clinical manifestations and renal active lesions of IgA nephropathy.