摘要
目的探讨血尿酸水平与IgA肾病(IgAN)患者临床、病理和预后的关系,以及通过干预血尿酸水平能否达到改善肾小球滤过率的效果。方法将确诊为IgAN且随访时间>5年的194例患者,根据血尿酸水平分为高尿酸血症组(47例)和血尿酸正常组(147例),比较两组患者的一般资料、临床资料和病理资料。随访过程中根据是否采取降尿酸治疗,将高尿酸血症组患者分为治疗亚组(10例)和非治疗亚组(37例),比较两亚组随访5年后与入组时估算的的肾小球滤过率(eGFR)。结果 IgAN患者高尿酸血症患病率为24.2%(47/194)。高尿酸血症组的男性比例、高血压患者比例,以及血尿素氮、三酰甘油和血肌酐水平均显著高于血尿酸正常组(P值分别<0.01、0.05),eGFR显著低于血尿酸正常组(P<0.01)。高尿酸血症组患者的系膜增生(χ~2=16.357)、节段性硬化肾小球(χ~2=31.144)、肾小管萎缩(χ~2=23.140)和间质纤维化(χ~2=10.709)的程度均显著重于血尿酸正常组(P值均<0.01)。随访5年后,治疗亚组的eGFR为(77.75±0.92) mL/min,显著高于入组时的(62.30±2.52) mL/min(P<0.05);非治疗亚组的eGFR为(58.15±7.22) mL/min,与入组时的(58.47±10.91) mL/min的差异无统计学意义(P>0.05)。结论伴高血尿酸的IgAN患者的临床病理表现较严重,预后较差,及时降低血尿酸水平具有重要的临床意义。
Objective To investigate the relationship between hyperuricemia and clinicopathological characteristics and prognosis in patients with IgA nephropathy.Methods A total of 194 patients with IgA nephropathy were followed up for over 5 years and were analyzed respectively.They were divided into two groups according to the level of blood uric acid:hyperuricemia group(n=47)and normal uric acid group(n=147).General information,clinical data and pathological manifestations were compared between the two groups.During follow up,the patients in hyperuricemia group were subdivided into treatment group(n=10)and non-treatment group(n=37),and estimated glomerular filtration rate(eGFR)was observed.Results The prevalence of hyperuricemia in patients with IgA nephropathy was 24.2%(47/194).The ratio of male to female,the proportion of hypertension patients,and the levels of blood urea nitrogen,triglyceride and serum creatinine in hyperuricemia group were significantly higher than those in normal uric acid group(P<0.01,0.05).The eGFR was remarkedly reduced in hyperuricemia group as compared with that in normal uric acid group(P<0.01).The presentations of mesangial proliferation(χ~2=16.357),segmental glomerulus sclerosis(χ~2=31.144),tubular atrophy(χ~2=23.140),and interstitial fibrosis(χ~2=10.709)in hyperuricemia group were more serious than those in normal uric acid group(all P<0.01).The eGFR was(77.75±0.92)mL/min in treatment group after 5-year follow-up,which was significantly higher than that before treatment([62.30±2.52]mL/min,P<0.05).In non-treatment group,no significant difference was found in eGFR after 5-year follow-up([58.15±7.22]mL/min vs.[58.47±10.91]mL/min,P>0.05).Conclusion The clinicopathological manifestations and prognosis are very bad in patients with IgA nephropathy accompanied with hyperuricemia.Better prognosis is shown in those receiving prompt treatment for hyperuricemia.
作者
孔凌云
蒋更如
KONG Lingyun;JIANG Gengru(Department of Nephrology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200082,China)
出处
《上海医学》
CAS
北大核心
2019年第7期407-410,共4页
Shanghai Medical Journal
关键词
肾小球胃炎
IgA
肾小球滤过率
预后
血尿酸
病理
Glomerulonephritis,IgA
Glomerular filtration rate
Prognosis
Blood uric acid
Pathology
