表现为蛋白尿合并血尿的成人IgA肾病患者肾脏病理与临床特点分析

Analysis of pathological and clinical features in adult patients with IgA nephropathy manifested by hematuria and proteinuria

目的分析蛋白尿合并血尿型免疫球蛋白A(IgA)肾病(IgAN)患者的临床特点,为临床诊治提供依据。方法选取2012年1月至2017年12月潍坊医学院附属医院肾内科收治的原发性IgAN患者41例,收集患者的临床资料,包括性别、年龄、病程、既往病史、血清学及免疫学指标、肾脏病理检查结果等,分析蛋白尿合并血尿型IgAN患者的肾脏病理与临床特点。结果41例患者中男28例(68.29%),女13例(31.71%);平均发病年龄(38.09±11.64)岁;病程37(3,240)个月;肾脏病理活检时间9(0.5,60)个月;表现为非特异性症状(乏力、腰痛)14例(34.15%);有吸烟史13例(31.71%),呼吸道前驱感染史17例(41.46%),高血压病史11例(26.83%),水肿18例(43.90%);尿常规检查:尿蛋白33例(80.49%),血尿38例(92.68%)。肾脏病理检查:肾小球纤维化30例(73.17%),硬化29例(70.73%),系膜增殖30例(73.17%),肾小管萎缩34例(82.93%),管型39例(95.12%),肾间质纤维化34例(82.93%),炎性细胞浸润41例(100.00%);免疫沉积物检查:IgA阳性38例(92.68%),补体C3阳性34例(82.93%);免疫物质沉积于系膜区35例(85.37%),沉积于毛细血管壁8例(19.51%)。结论蛋白尿合并血尿型IgAN患者以青年男性多见,常伴乏力、疲劳,有吸烟、呼吸道前驱感染、高血压病史多见,病理改变主要为肾小球纤维化、硬化,系膜增殖,肾小管萎缩和管型,肾间质纤维化、炎性细胞浸润,免疫沉积物主要为IgA、C3阳性,免疫物质主要沉积于系膜区;为蛋白尿合并血尿型IgAN的临床分型提供了思路,有助于及时、正确地诊治及评估患者预后。

Objective To analyze the clinical characteristics of IgA nephropathy(IgAN)with hematuria and proteinuria to provide a basis for its clinical diagnosis and treatment.Methods Forty-one patients with primary IgAN in the nephrology department of Affiliated Hospital of Weifang Medical College from January 2012 to December 2017 were sellected.The clinical data were collected,including the sex,age,disease course,past disease history,serological and immunological indexes,and renal pathologic examination results.The pathological and clinical features in the patients with hematuria and proteinuria type IgAN were analyzed.Results Among 41 cases,28 males(68.29%)and 13 females(31.71%),the mean onset age(38.09±11.64)years old,the disease course 37(3,240)months;the biopsy time of renal pathology 9(0.5,60)months;manifested by the non-specific symptoms(fatigue,lumbago)in 14 cases(34.15%),smoking history in 13 cases(31.71%),respiratory tract prodromic infection history in 17 cases(41.46%),hypertension history in 11 cases(26.83%),edema in 18 cases(43.90%);in urinary routine examination,urinary protein in 33 cases(80.49%),hematuria in 38 cases(92.68%);in renal pathological examination,glomerular fibrosis in 30 cases(73.17%),sclerosis in 29 cases(70.73%),mesangial infiltration in 30 cases(73.17%),tubule atrophy in 34 cases(82.93%),casts in 39 cases(95.12%),renal interstitial fibsosis in 34 cases(82.93%)and inflammatory cells infiltration in 41 cases(100.00%);in the immune deposits examination,IgA positive in 38 cases(92.68%),complement C3 positive in 34 cases(82.93%);there were 35 cases(85.37%)of the immune material deposition in mesangial region and 8 cases(19.51%)of capillary wall deposit.Conclusion The patients with hematuria and proteinuria type IgAN are mainly male young adults,this disease is commonly accompanied by lack of power,fatigue,smoking,respiratory tract prodromic infection and hypertension history.The pathological changes are mainly glomerular fibrosis,sclerosis,mesangial proliferation;renal tubular atrophy and casts,renal interstitial fibrosis,inflammatory cells infiltration;the immune deposits are mainly IgA,C3 positive;the immune materials mainly deposite in the mesangial area,which provide an idea for clinical classification of hematuria and proteinuria type IgAN and is helpful for timely,correct diagnosis,treatment and evaluation of prognosis.