摘要
目的分析少量蛋白尿Ig A肾病(Ig AN)患者临床特征,探讨少量蛋白尿Ig AN患者肾功能损伤相关危险因素。方法回顾性分析2015年12月至2016年12月于武汉大学人民医院肾内科住院治疗并确诊原发性Ig AN患者临床资料及病理资料,按照24h尿蛋白定量分为少量蛋白尿组(<1 g/24h)及中大量蛋白尿组(≥1 g/24h),并将少量蛋白尿组患者分为肾功能正常组[肾小球滤过率(e GFR)>90 ml·min^(-1)·(1.73 m^2)^(-1)]和肾功能受损组[e GFR<90 ml·min^(-1)·(1.73 m^2)^(-1)],比较各组临床资料及病理资料,分析各临床指标与肾功能损伤相关性并分析肾功能下降危险因素。结果 302例原发性Ig AN患者纳入本研究,其中少量蛋白尿患者116例(38.41%),中大量蛋白尿患者186例(61.59%)。少量蛋白尿组患者血肌酐、血尿素氮、血尿酸水平均明显低于中大量蛋白尿组,差异有统计学意义(均P<0.05)。慢性肾脏病分期以慢性肾脏病(CKD)1期为主,Lee氏分级以Lee氏Ⅰ～Ⅱ级为主。亚组间比较,肾功能损伤亚组患者年龄大,高血压及高尿酸血症患病率高,病理损伤较重,以Lee氏Ⅲ级为主,差异有统计学意义(均P<0.05)。多元线性回归分析显示,年龄及血尿酸与少量蛋白尿Ig AN患者e GFR呈负相关(均P<0.05)。结论少量蛋白尿Ig AN患者病理表现亦可能较重,年龄、血尿酸是预测少量蛋白尿Ig AN肾功能损伤独立危险因素,需积极干预治疗以改善患者预后。
Objective To analyze the clinical and pathological features of Ig A nephropathy patients presenting with mild proteinuria and to describe risk factors associated with kidney injury. M ethods The general and pathological data of patients with primary Ig A nephropathy treated in our department from December 2015 to December 2016 were analyzed retrospectively. According to the 2 4-h total proteinuria,patients were divided into mild proteinuria group(〈1 g/2 4 h） and massive proteinuria group(≥1 g/2 4 h）,and the mild proteinuria group was divided into renal dysfunction subgroup [e GFR〈 9 0 ml·min-1·(1. 73 m2）-1] and normal renal function subgroup [e GFR ≥9 0 ml·min-1·(1. 73 m2）-1]. The clinicopathological data of different groups and subgroups were compared and the risk factors of renal dysfunction were analyzed. Results Of 302 patients with primary Ig A nephropathy enrolled in this study,there were 116(38. 41%） cases of mild proteinuria and 186(61. 59%） cases of massive proteinuria. The levels of serum creatinine,blood urea nitrogen and blood uric acid in patients with mild proteinu-ria were significantly lower than those in patients with massive proteinuria. Patients with CKD 1 stage and Lee＇s Ⅰ-Ⅱ grades made up the most part of the mild proteinuria group,with the difference being statistically significant(P 〈0. 0 5）. As compared with the normal renal function subgroup,patients were older,the percentage of hypertension and hyperuricemia was higher,and pathological injuries were severer,mainly in the Lee＇s grade Ⅲ in the renal injury subgroup(P 〈0. 0 5）. Multiple linear regression analysis indicated that age and level of serum uric acid were negatively correlated with e GFR of patients with mild proteinuria(P 〈0. 0 5）.Conclusions The pathological lesions of Ig A nephropathy patients with mild proteinuria may be severe. Age and serum uric acid are independent risk factors for predicting renal dysfunction. Active intervention should be taken to improve the outcome of these
作者
刘杰
杨定平
LIUJie;YANG Ding-ping.(Department of Nephropathy , Renmin Hospital of Wuhan University, Wuhan 430060, Chin)
出处
《临床肾脏病杂志》
2018年第4期206-210,共5页
Journal Of Clinical Nephrology
基金
国家自然科学基金(No.81670631)
关键词
IGA肾病
蛋白尿
肾功能损伤
IgA nephropathy
Proteinuria
Renal function injury
