IgA肾病患者肾间质血管病变的临床及病理意义

Clinical and pathological significance of renal interstitial vascular lesions in the patients with IgA nephropathy

目的分析IgA肾病患者肾间质血管病变的临床及病理特点。方法将98例肾活检为原发性IgA肾病住院患者根据是否发生肾间质血管病变(血管壁增厚和/或玻璃样变),分成血管病变组和无血管病变组。分析2组患者间临床及病理指标的特点与关系。结果血管病变组患者收缩压、血清肌酐、尿素氮、血尿酸、甘油三酯及24 h尿蛋白定量明显高于无血管病变组患者(P<0.05)。血管病变组出现肾小管萎缩或间质纤维化、新月体及肾小球硬化的比例明显高于无血管病变组患者(P<0.05)。血管病变组患者Lee’s分级高于无血管病变组(P<0.05)。结论伴有肾间质血管病变的IgA肾病患者,其临床指标及病理损害更为严重,肾间质血管病变可以作为判断IgA肾病预后的一项重要病理指标。

Objective To analyze the clinical and pathological characteristics of renal interstitial vascular lesion in IgA nephropathy(IgAN)patients.Methods According to whether the renal interstitial vasculopathy(vascu1 ar wall thickening and/or hyalinization)occurred,98 inpatients with primary IgA nephropathy diagnosed by renal biopsy were divided into vascular disease group and non-vascular disease group.The characteristics and relationship of clinical and pathological indexes between the two groups were analyzed.Results Compared with the non-vascular disease group,the patients with interstitial vascular lesions had higher levels of systolic blood pressure(SBP),serum creatinine(Scr),blood urea nitrogen(BUN),uric acid(UA),triglyceride(TG)and 24 hour urinary protein(P<0.05).The percentage of tubular atrophy/interstitial fibrosis,crescentic change and glomerulosclerosis were significantly higher than those in non-vascular lesions group(P<0.05).The patients with interstitial vascular lesions had higher degree of Lee’s degree(P<0.05).Conclusions IgA nephropathy patients with renal interstitial vascular lesions have more severe clinical and pathological damage.Renal interstitial vscular lesions can be used as an important pathological index to predict the prognosis of IgA nephropathy.