IgA肾病伴高尿酸血症的临床、病理特点及相关因素分析

Clinicopathological characteristics and related factors of IgA nephropathy with hyperuricemia

目的分析IgA肾病伴高尿酸血症患者的临床指标与病理改变的特点,探讨其相关影响因素。方法回顾性选取2015年1月1日至2019年12月31日于新疆维吾尔自治区人民医院首次肾活检并明确诊断为原发性IgA肾病的患者共320例作为研究对象,根据其血尿酸水平分为高尿酸血症组(111例)及血尿酸正常组(209例),比较两组患者在临床与病理指标方面的差别,采用Logistic回归模型分析IgA肾病伴高尿酸血症患者的相关影响因素。结果320例IgA肾病患者中,合并高尿酸血症者占34.7%。临床指标方面,高尿酸血症组在男性患者比例、收缩压、舒张压、尿酸、血红蛋白、三酰甘油、尿素氮、肌酐、24 h尿蛋白定量上比血尿酸正常组高(P<0.05),而高密度脂蛋白、估算肾小球滤过率比血尿酸正常组低(P<0.05)。病理改变方面,高尿酸血症组在节段性肾小球硬化/黏连比例、肾小管萎缩/间质纤维化>25%比例上大于血尿酸正常组(P<0.05);进一步组间两两比较得出肾小管萎缩/间质纤维化>50%组的比例较肾小管萎缩/间质纤维化组<25%组及介于26%~50%组的比例大(P<0.05)。相关因素分析得出,估算肾小球滤过率是IgA肾病伴高尿酸血症的独立相关因素(P<0.05)。结论IgA肾病伴高尿酸血症患者在临床指标及病理改变方面均较血尿酸正常患者重,提示高尿酸血症可能与IgA肾病病情进展及预后不良有一定的相关性,综合控制尿酸、血压、血脂等水平有助于改善患者预后。

Objective To explore the clinicopathological characteristics of IgA nephropathy with hyperuricemia and examine the related influencing factors.Methods A total of 320 patients with primary IgA nephropathy receiving an initial renal biopsy from January 1,2015 to December 31,2019 were selected as research subjects.According to the serum level of uric acid,they were divided into two groups of hyperuricemia(n=111)and normal uric acid(n=209).The inter-group differences of clinicopathological parameters were compared.The relevant factors of IgA nephropathy with hyperuricemia were analyzed by a regression model.Results Among 320 patients with IgA nephropathy,34.7%had hyperuricemia.Proportion of male,systolic blood pressure,diastolic blood pressure,uric acid,hemoglobin,triglyceride,urea nitrogen,creatinine and 24-hour urine protein were higher in hyperuricemia group than those in normal uric acid group(P<0.05).However,high density lipoprotein and estimated glomerular filtration rate(eGFR)were lower than those in normal uric acid group(P<0.05).In terms of pathological changes,proportion of segmental glomerulosclerosis/adhesion and tubular atrophy/interstitial fibrosis>25%was higher in hyperuricemia group than that in normal uric acid group(P<0.05);further pairwise inter-group comparison indicated that proportion of tubular atrophy/interstitial fibrosis>50%group was higher than that in tubular atrophy/interstitial fibrosis<25%and 26%~50%groups(P<0.05).And eGFR was an independent factor of IgA nephropathy with hyperuricemia(P<0.05).Conclusion Clinicopathological changes of IgA nephropathy patients with hyperuricemia are more serious than those with normal serum uric acid.It implies that hyperuricemia may be correlated with the progression and poor prognosis of IgA nephropathy.A comprehensive control of uric acid,blood pressure and blood lipid helps to improve the prognosis of patients.