不同性别IgA肾病合并高尿酸血症患者的临床病理分析

IgA nephropathy combined with hyperuricemia in different genders:a clinicopathological analysis

目的探讨不同性别IgA肾病合并高尿酸血症患者的临床及病理相关因素。方法回顾性分析行肾穿刺活检确诊原发性IgA肾病的患者347例。将不同性别的患者分别分为高尿酸血症组和尿酸正常组。对患者的发病年龄、高血压患病率、血清肌酐、尿素、尿酸、胱抑素C、估算肾小球滤过率(eGFR)、血浆白蛋白、总胆固醇、甘油三酯等临床指标及系膜增殖、毛细血管内增生、节段性硬化、肾小管萎缩/间质纤维化、新月体、肾小球硬化废弃、小动脉管壁增厚、动脉透明变性等病理损伤特征进行比较,并对肾功能正常的患者进行分析。结果不同性别合并高尿酸血症的患者在年龄、高血压患病率、血清肌酐、尿素、胱抑素C.eGFR、甘油三酯等临床指标和系膜增殖、肾小球硬化/废弃、肾小管萎缩/间质纤维化、小动脉管壁增厚、动脉透明变性等病理损伤情况上均与同性别尿酸正常组存在差异(P<0.05)。女性高尿酸血症组患者的24 h尿蛋白明显高于尿酸正常组,而血浆白蛋白水平明显低于后者(P<0.05)。肾功能正常亚组中,不同性别高尿酸血症患者的高血压患病率均高于尿酸正常组。女性患者在24h尿蛋白、胱抑素C.eGFR、肾小球硬化/废弃及小动脉管壁增厚上与尿酸正常组存在差异(P<0.05)。男性患者则在肾小管间质损伤、小动脉管壁增厚及透明变性上较尿酸正常组严重(P<0.05)。结论不同性别的lgA肾病合并高尿酸血症患者在临床及病理损伤特点上均较同性别尿酸正常组更为严重。但不同性别的相关因素存在一-定的差异。女性与蛋白尿及肾小球硬化废弃更为密切,男性则与肾小管间质损伤及动脉透明变性更为密切。这可能与不同性别IgA肾病合并高尿酸t症的形成机制不同有关。

Objective To investigate the clinical and pathological factors of IgA nephropathy with hyperuricemia(HUA)in different genders.Methods The clinical and pathological data of 347 patients with primary IgA ne-phropathy diagnosed by renal biopsy were retrospectively analyzed.The patients were divided into HUA group and normal uric acid(NUA)group according to gender and uric acid level.Clinical indicators such as age of onset,prevalence of hypertension,serum creatinine(Ser),urea,urie acid(Ua),cystatin C(Cys C),estimated glomeru-lar filtration rate(eGFR),plasma albumin,total cholesterol(TC),triglyceride(TG),as well as mesangial prolifer-ltion,endocapillary prolferation,segmental sclerosis,renal tubular atropby/interstitial fibrosis,crescent forma-tion,glomerular sclerosis/obsolescence,arterial wall thickening,arterial hyalinization were measured or tested.The clinical and renal pathological characteristics between HUA and NUA patients of the same gender were respee-tively compared.And the patients with normal renal function were further analyzed.Results There were significant differences in age,prevalence of hypertension,Ser,urea,Cys C,eGFR-EPI,TG,renal tubular atrophy/intersti-tial fibrosis,arteriolar wall thickening,hyalinization,glomerular sclerosis/obsolescence and mesangial proliferation between male and female patients with HUA and those with NUA(P<0.05).The 24-hour urinary protein level in the female HUA group was significantly higher than that in the NUA group,while the serum albumin level was sig-nificantly lower than that in the latter group(P<0.05).In the normal renal function subgroup,the prevalence of hypertension in patients with HUA of different genders was higher than that in the NUA group.There were signifi-cant differences in 24-hour urinary protein,Cys C,eGFR-EPI,glomerular sclerosis/obsolescence and arteriolar wall thickening between HUA and NUA groups of female patients(P<0.05).In male patients with HUA,tubu-lointerstitial injury,arteriolar wall thickening and hyalinization were more serious than those in NUA group(P<0.05).Conclusion The clinical and pathological changes of patients with IgA nephropathy combined with HUA of different genders are more serious than those of NUA of the same gender.But there are some differences in elinico-pathological factors between different genders.W omen may be more closely associated with proteinuria and glomer-ular sclerosis/obsolescence,while men with tubulointerstitial injury and arterial hyalinization.This may be related to the different causes of IgA nephropathy with HUA in different genders.