无症状性IgA肾病的临床及病理特点分析

Clinical and pathological characteristics of asymptomatic IgA nephropathy

目的探讨无症状性IgA肾病患者的临床及病理特点。方法选取2019年1月至2021年12月收治的无症状性轻度蛋白尿IgAN患者163例,分析临床及病理特点。结果163例患者中有25例(15.34%)确诊时存在明显的肾功能损害[估算肾小球滤过率<60 ml/(min·1.73m^(2))]。在病理改变中,牛津分型中M141例(25.15%),E161例(37.47%),S152例(31.65%),T1-210例(6.13%)及C1-235例(21.47%)。节段肾小球硬化在血尿+蛋白尿组及单纯蛋白尿组中更高,而新月体形成在血尿+蛋白尿组中更高(P<0.05)。多因素Logistics回归分析结果显示,年龄、合并高血压、蛋白尿、有肾小球硬化及有新月体形成是无症状IgA肾病患者肾功能损害的独立影响因素(P<0.05)。结论较多无临床症状的IgA肾病患者仍然存在较突出的肾功能损害及较明显的肾脏病理病变。临床上需要充分重视,结合病理改变确定治疗方案。

Objective To observe the clinicopathological characteristics of asymptomatic IgA Nephropathy.Methods One hundred and sixty-three patients with asymptomatic IgA nephropathy and mild proteinuria were collected from January 2019 to December 2021 in our hospital.The clinical and pathological characteristics of the disease were analyzed.Results Of the 163 patients,25(15.34%)had significant renal impairment at diagnosis(estimated glomerular filtration rate<60ml/min/1.73m^(2)).Among the pathological changes,there were 41(25.15%)with M1,61(37.47%)with E1,52(31.65%)with S1,10(6.13%)with T1-2 and 35(21.47%)with C1-2 in Oxford classification.Segmental sclerosis was higher in the hematuria and proteinuria group and in the simple proteinuria group.Crescents in the hematuria and proteinuria group were higher(P<0.05).Logistic regression analysis results showed that age,hypertension,proteinuria,segmental sclerosis and crescents formation were independent influencing factors of renal function damage in patients with asymptomatic IgA nephropathy.Conclusions Most asymptomatic IgA nephropathy patients still have prominent renal function damage and obvious renal pathological lesions.Clinically,full attention should be paid to determine the treatment plan in combination with pathological changes.