伴活动性小管间质病变的IgA肾病的临床及病理分析

Clinical and pathology features of IgA nephropathy with active tubular interstitial lesions

目的探讨伴活动性小管间质病变的IgA肾病的临床表现和病理特点。方法回顾性分析本院2014年3月至2015年12月经肾活检确诊且具有完整临床资料的148例IgA肾病患者，其中伴活动性小管间质病变的IgA肾病23例（IgAN-ATIL组），与另外125例IgA肾病患者（对照组）比较，分析其临床及病理特点并对有统计学意义的指标进行多因素Logistic回归分析。结果伴活动性小管间质病变的IgA肾病占IgA肾病的15．5％；与对照组比较，IgAN—ATIL组发病年龄较大（P=0．007）；有抗生素、利尿剂、非甾体抗炎药（NSAIDs）等药物使用史患者所占比例较高（P〈0．001）；血清白蛋白（P=O．018）、eGFR（P=0．013）较低，肌酐（P=0．009）、尿素氮（P=0．003）、24h尿蛋白量（P=0．011）、尿中性粒细胞明胶酶相关载脂蛋白（neutrophilgelatinase—associated lipocalin，NAGL）（P〈0．001）、尿红细胞计数（P=0．007）较高；Lee分级等级较高，肾小管间质慢性病变以中度为主，而对照组以轻度为主。多因素分析提示年龄、用药史、尿NGAL是IgA肾病小管间质活动性病变的独立影响因素。结论伴活动性小管间质病变的IgA肾病患者较一般IgA肾病患者有更重的临床表现以及小管间质慢性病变，临床上应尽早干预；年龄、用药史（抗生素、利尿剂、NSAIDs等）、尿NGAL是IgA肾病小管间质活动性病变的独立影响因素。

Objective To investigate the clinical and pathological characteristics of IgA nephropathy （IgAN） in association with active tubular interstitial lesions. Methods 148 patients who were diagnosed as IgAN by renal biopsy and admitted to Zhejiang Provincial People＇s Hospital from March 2014 to December 2014 were enrolled. They were divided into IgAN with active tubular interstitial lesions group （IgAN-ATIL group, 23 patients） and IgAN without active tubular interstitial lesions group （control group, 125 patients）. Clinical and pathological characteristics were retrospectively analyzed. Multivariate logistic regression analysis was used to analyze the influence factors. Results The prevalence of ATIL in 148 IgAN patients was 15.5%. IgAN-ATIL group showed an older average age and more higher proportion of medication history （antibiotics, diuretics, nonsteroidal antiinflammatory drugs, etc） than those in control group. There were significant differences in Alb, eGFR, Scr, BUN, 24-hour urinary protein quantity, urinary NGAL and urinary RBC count between two groups （P 〈 0.05, respectively）. A moderate of tubulointerstitial lesions of IgAN-ATIL group was shown, while the control group was mainly mild lesions. Multivariate logistic regression analysis showed that age, medication history and the urinary NGAL level were independent risk factors of IgAN- ATIL. Conclusions IgAN patients with active tubular interstitial lesions had more severe clinical manifestations and chronic interstitial lesions. The age, medication history （antibiotics, diuretics, nonsteroidal anti-inflammatory drugs, etc） and the urinary NGAL level were independent risk factors of IgAN-ATIL.