伴慢性扁桃体炎IgA肾病患者的临床病理特征及预后分析

Clinicopathological features and outcomes of primary IgA nephropathy patients with chronic tonsillitis

目的探讨伴慢性扁桃体炎IgA肾病（IgAN）患者的临床及病理特征和预后。方法回顾性分析2006年1月至2011年12月于中山大学附属第一医院经肾活检确诊的原发性IgAN患者，比较伴或不伴慢性扁桃体炎的两组患者临床及病理特征。终点事件为进展至终末期肾脏病或血肌酐翻倍，分析比较伴或不伴慢性扁桃体炎患者的肾脏预后。结果研究纳入981例IgAN患者，病史伴慢性扁桃体炎的患者98例（9．99％）。与不伴慢性扁桃体炎组相比，伴慢性扁桃体炎组诱因为扁桃体炎急性发作的比例更高（P〈0．001），血IgA水平更高（P=0．012），肉眼血尿发生率更高（P=0．006）。肾脏病理指标方面，伴慢性扁桃体炎组与不伴慢性扁桃体炎组差异无统计学意义。伴慢性扁桃体炎组与不伴慢性扁桃体炎组的肾脏预后差异亦无统计学意义。结论伴慢性扁桃体炎的IgAN患者临床诱因为扁桃体炎急性发作、肉眼血尿比例、血IgA水平更高，但其肾脏病理改变和肾脏预后无显著差异。

Objective To explore the clinicopathological features and renal outcomes of primary IgA nephropathy （IgAN） patients with chronic tonsillitis. Methods Patients with biopsy- proven primary IgAN admitted to The First Affiliated Hospital, Sun Yat-sen University from January 2006 to December 2011 were enrolled. The clinicopathological features and renal outcomes of patients with and without chronic tonsillitis were retrospectively compared. The primary outcome was progression to end stage renal diseases and/or doubling of serum ereatinine. Results A total of 981 primary IgAN patients were enrolled and 98 patients （9.99%） had a history of chronic tonsillitis. Compared with patients without chronic tonsillitis, IgAN patients with chronic tonsillitis exhibited significantly higher prevalence of acute episodes of tonsillitis as a predisposition （P 〈 0.001）, higher serum IgA levels （P=0.012）, and higher prevalence of macrohematuria （P=0.006）. No significant difference in renal pathological features was observed in patients with and without chronic tonsillitis. Moreover, the renal outcomes were similar as regards IgAN patients with and without chronic tonsillitis. Conclusion IgAN patients with chronic tonsillitis had higher prevalence of acute episodes of tonsillitis and macrohematuria as well as higher serum IgA levels. However, IgAN patients with and without chronic tonsillitis showed no significant difference in renal pathological features and renal outcomes.