摘要
目的分析恶性高血压肾损害的临床特点及肾功能受损的危险因素.方法选取2016—2018年郑州大学第一附属医院肾脏病医院收治的恶性高血压肾损害患者103例,均经临床及肾穿刺活检确诊,回顾性分析其临床资料.肾损害病理类型包括原发性恶性高血压(A组)、IgAN伴恶性高血压(B组)、其他继发性恶性高血压.将A、B组进行差异性比较,分析恶性高血压肾损害的临床及病理特征,应用Logistic回归方程分析肾功能受损的影响因素.结果103例患者中,A组71例,B组21例,其他继发性恶性高血压11例.A组24h尿蛋白定量[M(QR)]低于B组,1.91(1.58)比3.18(3.65),z=-2.061,P=0.039;A组左室后壁厚度高于B组,12.92(2.00)比11.72(3.00),z=-2.176,P=0.030.A组缺血皱缩占97.2%(67/71),B组占61.9%(3/21),A、B两组比较χ^2=17.337,P<0.01.A组系膜细胞及基质增生、小动脉腔内血栓者占比低于B组(χ^2=15.139、5.748,P<0.01、P=0.017).二分类Logistic回归分析显示,贫血β=1.509,OR=4.521,95%CI1.333~15.332;尿酸β=0.008,OR=1.008,95%CI1.003~1.013;血浆白蛋白β=-0.155,OR=0.856,95%CI0.752~0.975.结论原发性恶性高血压肾损害者多表现为肾小球缺血皱缩,IgAN伴恶性高血压肾损害者则表现为增生硬化性肾小球肾炎.贫血、高尿酸血症是肾功能受损的危险因素.
Objective To analyze the clinical features of renal damage and the risk factors of impaired renal function in patients with malignant hypertension.Methods A total of 103 patients with malignant hypertensive nephropathy admitted to the First Affiliated Hospital of Zhengzhou University from 2016 to 2018 were selected.All patients were diagnosed by clinical and renal biopsy.The clinical data of them were retrospectively analyzed.Pathological types of renal damage included primary malignant hypertension(group A),IgAN with malignant hypertension(group B),and other secondary malignant hypertension.The differences between group A and group B were analyzed.The clinical and pathological features of renal damage in malignant hypertensive patients were analyzed.Logistic regression equation was used to analyze the influencing factors of renal impairment.Results Of the 103 patients,71 patients were in group A,21 patients in group B,and 11 patients were secondary to malignant hypertension.The 24-hour urinary protein quantification[M(QR)]in group A was lower than that in group B,1.91(1.58)vs.3.18(3.65),z=-2.061,P=0.039.Left ventricular posterior wall thickness in group A was higher than that in group B,12.92(2.00)vs.11.72(3.00),z=-2.176,P=0.030.The ischemic contraction in group A accounted for 97.2%(67/71),and that in group B accounted for 61.9%(3/21).The difference between group A and group B was significant(χ^2=17.337,P<0.01).The proportion of mesangial cells and stromal hyperplasia and small arterial thrombus in group A were lower than those in group B(χ^2=15.139,5.748,P<0.01,P=0.017).Two-variant Logistic regression analysis showed that anemiaβ=1.509,OR=4.521,95%CI 1.333-15.332;uric acidβ=0.008,OR=1.008,95%CI 1.003-1.013;plasma albuminβ=-0.155,OR=0.856,95%CI 0.752-0.975.Conclusions Primary malignant hypertensive nephropathy is characterized by glomerular ischemic contraction,and IgAN with malignant hypertensive nephropathy is characterized by hyperplastic sclerosing glomerulonephritis.Anemia and hyperuricemia are risk f
作者
陶陈洋
尚进
窦艳娜
刘栋
肖静
程根阳
赵占正
Tao Chenyang;Shang Jin;Dou Yanna;Liu Dong;Xiao Jing;Cheng Genyang;Zhao Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Institute of Nephrology,Zhengzhou University,Zhengzhou 450052,China)
出处
《中国实用医刊》
2019年第14期3-6,共4页
Chinese Journal of Practical Medicine
基金
国家自然科学基金项目(81570690).
关键词
恶性高血压
肾功能受损
肾小球肾炎
Malignant hypertension
Impaired renal function
Glomerular nephritis
