IgA肾病患者病理与临床指标的相关性分析

Correlation between pathology and clinical indexes in IgA nephropathy patients

目的·分析肾活检病理确诊IgA肾病患者的病理与临床资料,研究IgA肾病患者的临床指标与患者肾脏病理损伤程度的相关性。方法·回顾性分析同济大学附属东方医院肾内科2012—2016年期间肾活检病理确诊为IgA肾病的73例患者的病理资料,比较不同病理分级、分型和损伤程度的患者血压、血尿酸、血肌酐、血尿素氮、24h尿蛋白定量、估算的肾小球滤过率(eGFR)、三酰甘油、总胆固醇、补体C3等临床指标,并进行相关性分析。结果·73例IgA肾病患者平均年龄为(37.07±12.58)岁,男女比为1.21∶1。不同Hass分级和不同牛津病理分型的患者,其血尿酸、血肌酐、血尿素氮及eGFR间差异有统计学意义(均P<0.05)。血清补体C3水平及肾组织局部免疫荧光沉积强度与病理分级间存在相关性,即血清补体C3水平越低,免疫荧光沉积越强,其病理分级越严重,肾功能损害也越严重。结论·IgA肾病患者的临床指标可用于预测患者肾脏病理损伤程度,血尿酸、血肌酐、血尿素氮、eGFR及血清补体C3水平可作为临床早期判断患者病理损伤程度和病程进展的指标。

Objective · To analyze pathology and clinical indexes of the patients diagnosed as IgA nephropathy by renal biopsy so as to determine the correlation between the clinical indexes and the extent of renal pathological damage. Methods · The pathological files of 73 patients with IgA nephropathy confirmed by renal biopsy in East Hospital affiliated to Tongji University from 2012 to 2016 were retrospectively analyzed. Clinical indexes, such as blood pressure, serum uric acid, serum creatinine, blood urea nitrogen, 24 h urine protein quantitation, evaluated glomerular filtration rate （eGFR）, triacylglycerol, total cholesterol and complement C3, were compared among the patients with different grades, types and extents of IgA nephropathy. The correlations were also conducted. Results · The 73 patients with IgA nephropathy had an average onset age of （37.07±12.58） years old, whose male to female ratio was 1.21：1. The results showed that there was statistic difference in the indexes of serum uric acid, serum creatinine, blood urea nitrogen and eGFR among the different Hass grades and Oxford pathological classification （P〈0.05）. Besides, serum complement C3 level and partial immunofluorescence sediment intensity of kidney were correlated with pathological types. The lower serum complement C3 level was, the stronger immunofluorescence sediment intensity was, the severer pathological grading was, and the worse renal function was. Conclusion · The clinical parameters of IgA nephropathy patients can be used to predict the extent of renal pathological damage. Serum uric acid, serum creatinine, blood urea nitrogen, eGFR and serum complement C3 level can be used as the indexes to judge the degree of pathologic damage and the progression of the disease at early stage.