伴有高血压的IgA肾病临床表现、病理特点及高血压发生的影响因素分析

A Study on Clinical and Pathological Characteristics of IgA Nephropathy Patients Associated with Hypertension and Influential Factors of Hypertension Pathogenesy

目的探讨伴有高血压的Ig A肾病(Ig AN)的临床表现、病理特点及影响高血压发生的相关因素。方法选取2013年1月—2015年12月收治的经肾穿刺活检术确诊为Ig AN的82例。根据血压状况分为高血压组(A组)33例和非高血压组(B组)49例。分析两组一般情况、临床表现和病理资料,比较两组临床指标和病理特点。结果A组贫血、高尿酸血症、肾功能不全发生率高于B组(P<0.05),而水肿、血尿的发生率比较差异无统计学意义(P>0.05)。A组24 h尿蛋白定量高于B组,病理损害重于B组(P<0.05)。A组病理类型以系膜增生性肾小球肾炎为主,占60.61%。A组肾小球硬化和血管病变发生率高于B组,肾间质病变程度较B组重,新月体形成率低于B组(P<0.05)。24 h尿蛋白定量、高尿酸血症、系膜增生、肾小球硬化、肾间质病变、动脉内膜增厚及透明变性与Ig AN高血压的发生呈正相关,而新月体形成与其呈负相关(P<0.05)。多因素Logistic回归分析结果显示,24 h尿蛋白定量为Ig AN高血压发生的独立危险因素。结论伴高血压的Ig A肾病患者贫血、高尿酸血症、肾功能不全发生率高,24 h尿蛋白定量高,病理损害重。

Objective To investigate clinical and pathological characteristics of IgA nephropathy patients associated with hypertension（ IgAN） and influential factors of hypertension pathogenesy. Methods A total of 82 inpatients with IgA nephropathy confirmed by renal needle biopsy during January 2013 and December 2015 were divided into hypertension（ group A,n = 33） and non-hypertension groups（ group B,n = 49）. General conditions,clinical manifestations and pathological data were retrospectively analyzed and clinical indexes and pathological characteristics were compared between two groups. Results In group A,incidence rates of anemia,hyperuricemia and renal insufficiency were significantly higher than those in group B（ P〈0. 05）,but there were no significant differences in incidence rates of edema and macroscopic hematuria（ P〈0. 05）. In group A,urinary protein quantitation within 24 h was more,and degree of pathological changes was worse compared with those in group B（ P〈0. 05）. The most common pathological type was mesangioproliferative glomerulonephritis in group A,which counted 60. 61%. In group A,incidence rates of glomerulosclerosis and vasculopathy were higher,and degree of renal interstitial lesions was more severe,and crescent formation rate was lower compared with those in group B（ P〈0. 05）. Urinary protein quantitation within 24 h,hyperuricemia,mesangial proliferation,glomerular sclerosis,renal interstitial lesions,arterial intimal thickening and hyaline degeneration were positively correlated with IgAN hypertension pathogenesy,and negatively correlated with crescent formation（ P〈0. 05）.Multivariate logistic regression analysis showed that urinary protein quantitation within 24 h was independently risk factor of hypertension pathogenesy in patients with IgAN. Conclusion Incidence rates of anemia,hyperuricemia and renal insufficiency are high in IgAN patients with more urinary protein quantitation within 24 h and worse pathological damage.