106例伴有慢性肾功能不全的IgA肾病患者肾活检的临床价值

Clinical evaluation of renal biopsy in 106 patients of IgA nephropathy with chronic renal failure

目的 了解IgA肾病患者出现慢性肾功能不全时的肾脏病理学特征及其与临床的关系。方法 分析106例伴有慢性肾功能不全的IgA肾病患者的临床和病理资料,根据患者血肌酐水平分为3组,分别按Lee分级标准和Hass分型标准将肾脏的病理改变分级,Katafuchi半定量积分法判断肾小球、肾小管间质及血管的病变程度。研究血肌酐水平(Scr)、内生肌酐清除率(CCr)和临床其它指标以及肾脏病理各项指标的相关性,多元回归分析影响血肌酐水平的因素。结果 106例患者全部为LeeⅣ～Ⅴ级或HassⅣ～Ⅴ型。Scr>266μmol/L的患者Lee Ⅴ级/Hass Ⅴ型的患者数量明显高于另外两组(P<0.05),肾脏病理总积分和间质积分均与其它两组患者差异有显著性意义(P<0.05)。尿蛋白定量、肾小球全球硬化程度、间质积分均与Scr、Ccr有显著相关性(P<0.05),肾小管萎缩、间质纤维化与Scr、Cer均显著相关(P<0.01)。肾小管萎缩是预测肾功能的独立因素(P<0.01)。结论 IgA肾病患者出现肾功能不全时,肾脏病理学主要特征为全球硬化比例高,肾小管间质损害突出。尿蛋白量以及间质病变与肾功能损害程度显著相关,肾小管萎缩程度是预后不良的重要因素。因此,对于伴有慢性肾功能不全的IgA肾病患者,当问质有大量炎细胞浸润时应给予相应治疗,同时要积极控制蛋白尿和高血压,

Objective To study renal pathological characteristics in patients of IgA nephropathy (IgAN) with chronic renal failure and their relation to clinic. Methods Clinical and pathologic findings from 106 patients of IgAN with chronic renal failure in our department were reviewed. All patients were divided into three groups according to their serum creatinine level(Scr). The activity and severity of the renal lesions were graded according to Lee SM and Hass M classifications. Change of glomeruli, renal tubules, interstitia and vessels were evaluated according to Katafuchi semiquantitative scoring system. The relationship between renal functions and other clinicopathological factors was studied. Predicted factors affecting serum creatinine were analyzed using step-wise multiple variance regression analysis. Results Renal pathological changes of all patients were grade IV or V respectively according to classification of Lee SM or Hass M. The amount of patients of grade V in the group whose Scr > 266 u,rnol/L was larger than that of other two groups (P < 0. 05) and total pathological score, interstitial score were higher than that of other two groups ( P < 0. 05) . The proteinuria, glomerular sclerosis and interstitial score were correlated to serum creatinine and creatinine clearance (P < 0. 05) . The tubular atrophy and interstitial fibrosis were significantly correlated to Scr/Ccr ( P < 0. 01) . The tubular atrophy was the factor predicting the renal functions( P < 0. 01). Conclusions Severe glomerular sclerosis and tubulointerstitial lesions are the main pathological characteristics in patients of IgAN with renal dysfunction. The degree of proteinuria and tubulointerstitial lesions have significant correlation with renal function. Control of proteinuria and antiinflammation treatment in the interstitia may delay the progress of renal function impairment in patients of IgAN with chronic renal failure.