新疆地区IgA肾病临床病理特点及危险因素分析

Analysis about the clinical pathological heterogeneity and risk factors with IgA nephropathy in Xinjiang

目的探讨新疆地区IgA肾病临床与病理间的关联性,为指导诊疗提供依据。方法通过回顾性分析2004年1月1日-2014年1月1日在本科经过肾活检确诊的354例维吾尔族、汉族原发性IgAN患者为研究对象,进行临床和病理资料分析。结果 354例IgAN患者中,平均(33.7±23.3)岁,男女比例为2.3:1,其中维吾尔族124例,汉族230例,在肾活检时,eGFR为(143±49.7)mL/min/1.73m^2。基线蛋白尿为(1.54±1.93)g/d。维吾尔族与汉族IgA肾病患者在临床表现方面二者无特殊不同,维吾尔族与汉族病理表现方面,在M1(77.4%&88.7%)、S1(79%&65.5%)、新月题形成(41.9%&24.3%)、血管病变(12.9%&33.9%)方面两组比较差异有统计学意义(P<0.05)。Katafuchi积分病理指标中活动性病变,间质炎性细胞浸润与血尿呈中度相关(r=0.511)。多因素COX风险回归分析,T1((P<0.0001),T2(P<0.0001)和M1评分(P=0.017)与肾脏预后显著相关,是影响IgA肾病预后的独立危险因素。22例维吾尔族患者重复肾活检,发现两次肾活检前后除较少患者病理指标发生进展,小管-间质病变、球形硬化比例、小动脉病变有增加外,多无显著转型。结论在新疆地区IgA肾病汉族与维吾尔族临床表现与病理类型存在不一致性。单纯通过现有临床指标判断预后、调整治疗已经不能满足需要,迫切需要寻找无创生物标志物为临床提供判别依据。

Objective To explore the relationship between clinical manifestations and pathological changes in patients with IgA nephrophathy in Xinjiang and draw a basis for clinical guideline.Methods The clinical pathological data of 354 patients with primary IgA nephrophathy from January 2004 to December 2014 were compared.Results Among the 354 patients,the average age was 33.7± 23.3 years old,and the ratio of males and females was 2.3：1.Among all the cases,124 cases were uygur,230 cases were Han.eCFR was（143 ± 49.7）mL/mirdl.73m2 Albuminuria baseline was 1.54 ± 1.93 g/d.The clinical symptom between Uygurs and Han patients with IgA nephropathy had no special difference.Pathological aspects between Uygnr and Han patients in M1（77.4% ＆ 88.7%）,Sl（79% ＆ 63.5%）,crescent formation（41.9% ＆ 24.3%）,vascular lesions（12.9% ＆ 33.9%）were different between the two groups（P 〈 0.05）.In Katafuchi d integrative pathological index,there was moderate correlation between interstitial inflammatory cell infiltration and hematuria（r =0.511）.Multiariable COX regression analysis,T1（P 〈 0.0001）,T2（P 〈 0.0001）and M1（P = 0.017）was the independent risk factors affecting the prognosis of IgA nephropathy.In 22 Uighur patients renal biopsy were repeated,and it was foundCthat before and after renal biopsy,most of biopsy had not changed except that tubular interstitial lesions,spherical hardening ratio,simdl artery lesions had increased.Conclusion There was inconsistency between the clinical manifestations and pathological types of IgA nephropathy between Uygur and Han patients in Xinjiang.It is urgent to find non-invasive biomarkers to provide a diagnostic basis for the diagnosis and adjusting treatment.Key words：Xinjiang region;IgA nephropathy;Clinicopathologic features;Risk factors