IgA肾病临床特征及肾脏病理与高尿酸血症的相关性分析

Correlation Between Clinical Features and Pathology of IgA Nephropathy and Hyperuricemia

目的:分析探讨IgA肾病(IgA nephropathy,IgAN)患者临床特征及肾脏病理与高尿酸血症(hyperuricemia,HUA)之间的相关关系,进一步了解IgAN诊治,为临床诊疗提供依据。方法:回顾性分析复旦大学附属中山医院厦门医院肾内科经过肾穿刺活检术确诊的235例原发性IgAN患者的临床资料及病理分型,将其根据血尿酸水平分为高尿酸血症组(HUA组)和血尿酸正常组(normal uric acid,NUA组),进行临床相关指标及肾脏病理的相关分析。结果:235例IgAN患者中,男女比例1.45∶1,年龄17~72岁,平均年龄(40.4±12.9)岁。HUA组患者88例,患病率为37.4%,男性易发(76.1%vs49%)(P<0.01)。与NUA组相比,HUA组患者的BMI、血压、血尿素氮、血肌酐、eGFR、胱抑素C、血同型半胱氨酸、血β2微球蛋白、视黄醇结合蛋白、血总胆固醇、血三酰甘油、24 h尿蛋白定量水平明显升高,高密度脂蛋白胆固醇水平明显降低(P<0.05)。高血压及慢性肾脏病分期与HUA密切相关。肾脏病理牛津分型主要表现为M1E0S1T0C0,Lee分级主要表现为Ⅲ级,HUA组患者肾脏病理突出表现为肾小球硬化比例增多、肾小管萎缩/间质纤维化病变重。经多因素Logistic回归分析提示血压、eGFR、RBP、CKD2期、CKD3期为IgAN伴高尿酸血症的危险因素。结论:IgAN患者HUA患病率较高,其临床指标、CKD分期及肾脏病理均相对较重,强化尿酸管理可能有助于延缓IgAN进展。

Objective:To analyze and explore the clinical characteristics of patients with IgA nephropathy and the relationship between renal pathology and hyperuricemia(HUA),to further understand IgA nephropathy,and to provide a basis for clinical diagnosis andtreatment.Methods:The clinical data and pathological types of 235 patients with primary IgA nephropathy diagnosed by renal biopsy in the Department of Nephrology,Zhongshan Hospital Affiliated with Fudan University,Xiamen Hospital were retrospectively analyzed.he relevant clinicalindicatorsand renal pathologywere analyzed.Results:Among the 235 patients with IgA nephropathy,the male-to-female ratio was 1.45∶1,the age ranged from 17 to 72 years old,and the average age was(40.4±12.9)years old.There were 88 patients in HUAgroups,the prevalence rate was 37.4%,and men were prone to it(76.1%vs 49%)(P<0.01).Compared with NUA group,BMI,blood pressure,blood urea nitrogen,blood creatinine,eGFR,cystatin C,blood homocysteine,bloodβ2 microglobulin,retinol binding in patients with HUA group The protein,total blood cholesterol,blood triglyceride,and 24 h urine protein quantitative levels were significantly increased,and the high-density lipoprotein cholesterol level was significantly decreased(P<0.05).Hypertension and chronic kidney disease stages are closely related to hyperuricemia.The Oxford classification of renal pathology is mainly manifested as M1E0S1T0C0,and the Lee classification is mainly manifested as gradeⅢ.The renal pathological features of patients with hyperuricemiaare mainlymanifested as an increased proportion ofglomerulosclerosis and severe tubular atrophy/interstitial fibrosis.Multivariate Logistic regression analysis suggested that blood pressure,eGFR,RBP,CKD2,and CKD3 were risk factorsforIgAwithhyperuricemia.Conclusion:The prevalence ofIgAnephropathywithhyperuricemia isrelatively high,and its clinical indicators,CKD stage,and renal pathology are relatively severe.Therefore,the control of blood uric acid should be strengthened to help delay the disease progression.