摘要
目的探讨IgA肾病发生慢性肾功能不全的相关危险因素。方法选取1997—2006年广西医科大学附属第一医院肾内科384例IgA肾病患者,按血肌酐水平,分为肾功能正常组(320例)和肾功能不全组(64例),对比分析两组患者临床病理资料,多元回归分析探寻影响患者肾功能的相关危险因素。结果男性、水肿、高血压、蛋白尿发生率在肾功能不全组显著增多(P<0.05),以蛋白尿发生率最高(OR=6.14);与肾功能正常组相比,年龄、血压、尿蛋白水平、血IgA等多项参数差异均有显著性意义(P<0.05),但病程长短差异无显著性意义;免疫沉积物半定量分析显示,仅IgG的沉积两组间比较差异有显著性意义,且是肾功能正常组高于肾功能不全组(P<0.01),IgA、IgM、C3、C4、C1q和FG的沉积比较差异均无显著性意义(P>0.05)。病理评分各指标在肾功能不全组均显著增高(P<0.01)。回归分析显示,与血肌酐水平相关的参数按影响力大小依次是硬化指数、尿蛋白、性别等。结论影响肾功能最危险的因素是蛋白尿,其余依次为男性和高血压,年龄大、血IgA水平高和严重的肾脏病理改变也是肾功能预后差的相关指标;病程长短不是肾功能不全进展的必要条件,肾脏免疫复合物可能也不是肾功能不全的可靠标志。
Objective To investigate risk factors of chronic renal failure in IgA nephropathy. Methods A total of 384 cases of patients with IgA nephropathy from the First Affiliated Hospital of Guangxi University in Guangxi during 1997-2006 were divided into renal function normal group（ 320 cases） as the contrast and renal dysfunction group（64 cases） according to serum creatinine level whether beyond 133 μmol/L, clinical and pathological materials were contrasted,stepwise multiple variance regression analysis was adopted to find the serum creatinine related factors. Results Significant difference was found between the two groups in rates of maleness, dropsy, hypertension, proteinuria, which were remarkably increased in the renal dysfunction group（P 〈0. 05） ,the odds ratio of proteinuria being as high as 6. 14. Compared with the renal normal group, the data of age, blood pressure, urine protein, and serum IgA level and so on of the patients in the renal dysfunction group were higher（ P 〈 0. 05 ）, but no significant difference in duration. Demonstrated by immunity deposit semi-quantity analysis, only IgG deposition had difference （P 〈 0. 01 ）, but more deposition was found in the contrast. No statistical significance found in deposition of IgA, IgM, C3, C4, C1q and FG（ P 〉 0. 05 ）. The scores of glomeruli index,interstitial index, blood vessel index, sclerotic index and so on were remarkably higher in the renal dysfunction group（ P 〈 0. 01 ）. By regression analysis,serum creatinine level was strongly related to sclerotic index, level of urine protein,masculine sex,etc. Conclusion The most dangerous factor is proteinuria,maleness and hypertension. Others such like alder,high serum IgA level and serious kidney pathology change also were related to poor renal survival;Duration might not be the essential condition in IgA nephropathy progression;however,renal local depositions might not be reliable symbols.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第6期438-440,共3页
Chinese Journal of Practical Internal Medicine
基金
广西省自然科学基金(0640097)
