单纯性血尿IgA肾病临床病理回顾性分析

Clinicopathological Review of Simple Hematuria IgA Nephropathy

目的:分析临床表现为单纯性血尿的IgA肾病(IgAN)患者的临床和病理特点,进一步了解该类IgAN,为指导诊疗提供依据。方法:2010年12月1日至2016年6月1日在深圳市第二人民医院肾内科经过肾活检确诊的IgAN患者494例中选取符合研究标准的患者21例进行回顾性分析,用多因素logistic回归法分析肾脏病理损伤的危险因素。结果:(1)21例单纯性血尿的IgAN患者中男9例,女12例,男女比例0.75:1,年龄17~46岁,平均年龄(30.2±6.7)岁。伴发高血压2例(9.5%),高尿酸血症4例(19.0%),高脂血症6例(28.6%),CKD分期为1~2期。肾脏病理Lee氏分级为Ⅰ~Ⅲ级,以Ⅱ级为主(66.6%);牛津分类法以M1S0E0T0为主(85.7%)。(2)按照肾脏病理Lee氏分级分为Ⅰ、Ⅱ级组和Ⅲ级组,两组之间的血红蛋白、血清白蛋白、肌酐、尿酸、血脂4项均无统计学差异。(3)多因素logistic回归分析显示,SCr、Alb及Hb是肾脏病理损伤较重的危险因素(OR值分别为1.851、0.639和0.948,P<0.05)。结论:相对于所有的IgAN人群,在单纯性血尿IgAN患者中,肾脏病理和肾功能损伤均较轻,高血压、高尿酸血症和高脂血症的发病率均较低。

Objective To analyze the clinicopathological features and in order to provide the basis for guiding diagnosis and treatment of IgA nephropathy with simple hematuria. Methods From December 1, 2010 to June 1, 2016, there were 494 patients with primary IgA nephropathy diagnosed by renal biopsy in Shenzhen 2nd people＇s hospital. Among these patients, 21 eligible patients who were IgA nephropathy with simple hematuria were enrolled in as the research object. Analysis of risk factors of renal pathological injury by multivariate logistic regression. Results 1. Among 21 IgA nephropathy patients with simple hematuria, 9 cases were male and 12 cases were female（male： female ratio 0.75： 1）, the age range was 17 - 46 years old , and the average age was 30.2 ± 6.7. Among 21 patients, there were 2 cases with hypertension（9.5 %）, 4 cases with hyperuricemia（19.0 %）, 6 cases with hyperlipidemia（28.6 %）. Their CKD stage was stage 1 - 2, renal pathology Lee＇s grade was gradeⅠ - Ⅲ, most were Lee＇s grade Ⅱ （66.6 %）, and most were M1SOEOT0 in Oxford classification（85.7 %）. 2. These patients were divided into grade Ⅰ ~ Ⅱ and grade Ⅲ groups according to renal pathology Lee＇s grade. There were no statistical differences in the hemoglobin, serum albumin, creatinine, uria acid, blood lipid of two groups. 3. Multivariate Logistic regression analysis showed that serum creatinine, albumin and hemoglobin were all risk factors of renal pathological serious damage（OR=1.851, 0.639, 0.948, P 〈 0.05）. Conclusion Relative to all IgA nephropathy, the damage of renal pathological and renal function was lighter, the morbidity of hypertension, hyperuricemia and hyperlipidemia was lower in IgA nephropathy with simple hematuria.