摘要
目的:探讨原发性IgA肾病(IgAN)患者肾间质血管病变与临床表现及肾活检病理改变的联系。方法:收集经临床及肾活检确诊的507例原发性IgAN患者的肾活检标本,根据光镜下血管组织学特点,将肾间质血管病变分为4型:透明变性(HL)型、动脉硬化(AS)型、炎细胞浸润(CI)型和纤维素变性坏死(FN)型。肾小管间质病变程度采用半定量积分评价,比较不同类型血管病变IgAN患者的临床表现、实验室检查及肾活检病理特点。结果:①366例(72.2%)存在血管病变,其中HL型151例(29.8%)、AS型140例(27.5%)、FN型43例(8.5%)和CI型32例(6.3%),141例(27.8%)无血管病变。②伴有血管病变的各组其肾功能不全、高血压发生率高、尿视黄醇结合蛋白(RBP)水平高于无血管病变(NRVL)组;肾活检肾小球球性及节段硬化、小管间质病变积分均高于NRVL组。而尿蛋白水平低于NRVL组。FN型、CI型肉眼血尿发生率最高。③FN型、CI型襻坏死及新月体比例显著增高,HL型及AS型襻坏死比例与NRVL组相比差异无显著性意义。结论:IgAN肾间质血管病变发生率高,且类型不同,不同类型血管病变与临床表现及肾活检病理改变密切相关,临床上应分别对待。
Objective:To analyse the Clinico-pathological features of primary IgA nephropathy (IgAN) with different types of renal vascular lesions (RVLs). Methods: 507 patients with primary IgAN proven by renal biopsy and clinico-manifestations were enrolled in this study. Renal vascular lesions were divided into four subgroups according to histological characteristics by light microscope. They were hyalinosis (HL), arteriosclerosis (AS), cellular infiltration (CI) and fibroid necrosis lesion (FN). Renal tubulointerstitial lesions were semi-quantatitively scored. Clinical and renal histological characteristics were compared among different groups of renal vascular lesions. Results: ①366 patients(72.2%) were found to have different RVLs. The incidences of the HL, AS, FN and CI were 29.8%, 27.5%, 8.5% and 6.3%, respectively. There were 141 patients with no RVLs (NRVL). ②In the patients with RVLs, the incidences of renal insufficiency,hypertension, and the scores of global glomerulosclerosis, segmental glomerulosclerosis, and tubulointerstitial were higher than those in NRVL group. So did urinary RBP levels. But urinary protein levels were lower. In the patients of FN group and CI group, the incidences of gross hematuria were significantly higher than those in any other groups ③ In the patients of FN group and CI group,the incidences of capillary necrosis and crescent were significantly higher than those in any other groups. For the patients of AS and HL groups, their incidences of capillary necrosis were not different from that of NRVL group. Conclusion: In patients with IgAN, renal vascular lesions are common and variant. Renal vascular lesions parallel with the clinical and renal histopathological features. Classified vascular lesions may be used to define the severity of renal disease, and to guide the treatment.
出处
《医学研究生学报》
CAS
2005年第5期432-436,共5页
Journal of Medical Postgraduates
