血管病变在1005例IgA肾病中的意义及其影响因素

Significance of vascular lesions in IgA nephropathy and their influencing factors, a study of 1 005 cases

目的 探讨IgA肾病血管病变的意义及其发生的影响因素。方法 分析1987年12月至2002年6月经肾活检诊断的1005例IgA肾病患者的临床指标(病程、血压、肾功能改变、血脂)及病理改变与血管病变的关系。结果 1005例IgA肾病患者中有不同程度的血管病变者占54.6％,其中轻度占34.4％,中度占15.1％,重度占5.1％。重度血管病变组患者较其他各组临床病情加重,表现为血压更高、血肌酐及尿蛋白定量等;病理改变也更重,表现为病理分级加重,系膜增殖、全球硬化、肾小管萎缩、间质纤维化等病变积分增加,间质血管壁C_3沉积的比例增多。多因素分析显示高血压、高尿酸血症、全球硬化≥50％、间质炎细胞浸润面积≥50％、病理分级Ⅲ级以上(Lee分级)对血管病变的发生影响有显著意义。结论 在IgA肾病中血管病变与血压、甘油三酯、尿蛋白定量、血肌酐水平等临床指标及肾小球、肾小管、间质的病理改变相平行,能够反映病变的程度,可以作为判断预后及干预治疗的一个重要病理指标。

Objective To analyze the characteristics of vascular lesions and their influencing factors in IgA nephropathy (IgAN). Methods The clinical and pathologic materials of 1 005 IgAN patients were analyzed. Results Of the 1005 IgAN patients 54.6% were with vascular lesions. The patients with vascular lesions were older, underwent renopuncture earlier, and had a longer duration of disease than those without vascular lesions (all P< 0.01) .The patients with severe vascular lesions were older and underwent renopuncture at older age in comparison with those with mild vascular lesions ( P < 0.05 and P < 0.01) . The patients with moderate vascular lesions had a longer course than those with mild lesions ( P < 0.01) . The systolic pressure and diastolic pressure of patients with severe, moderate, and mild vascular lesions were higher than those in patients without vascular lesions (all P <0.01) . The systolic pressure and diastolic pressure were significantly higher in the patients with severe vascular lesions than in those with mild vascular lesions ( P < 0.01 and P < 0.05) . The serum triglyceride level was significantly higher in the patients with severe, moderate, and mild vascular lesions than in those without vascular lesions (all P < 0.01) . The serum triglyceride level was significantly higher in the patients with severe vascular lesions than in those with mild vascular lesions ( P < 0.01) . The levels of urine protein of all patients with vascular lesions were significantly higher than that of those without vascular lesions (all P < 0.01) . The urine protein level was significantly higher in the patients with severe vascular lesions than in those with moderate and mild vascular lesions (both P < 0.01) . The serum creatinine was higher in all patients with vascular lesions than in those without vascular lesions (all P < 0.01) and was significantly higher in the patients with severe and moderate vascular lesions than in those with mild vascular lesions ( P < 0.05 and P < 0.01). The blood albumin level was significandy lower in all patients with vascular lesions than that in those without vascular lesions ( all P < 0.01). The higher the pathological grade of the nephropathy, the more severe the vascular lesion ( P < 0.01) . The C3 deposition along the interstitial vascular wall was more severe in those with vascular lesions than in those without vascular lesions (P < 0.01) . Multivariate logistic regression analysis showed that the significant influencing factors on vascular lesions included hypertension, high serum uric acid, global glomerular sclerosis (≥50%), interstitial inflammation ( ≥50%) and pathological grade Ⅲ-Ⅴ. Conclusion In patients with IgAN, vascular lesion parallels the blood pressure, serum triglyceride, urine protein, serum creatinine, etc. It reflects the disease degree and can be used as an important histological prognostic indicator.