吸烟对原发性IgA肾病患者的临床及病理指标的影响

发布时间：2018-01-03 04:38

本文关键词：吸烟对原发性IgA肾病患者的临床及病理指标的影响　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨吸烟对原发性IgA肾病患者临床及病理指标的影响方法:选取我院肾内科经首次肾穿刺活检确诊为IgA肾病的住院患者324例为研究对象。根据有无吸烟史分为吸烟组和非吸烟组。比较两组患者的临床指标(性别、年龄、血压、24小时尿蛋白定量、尿素、肌酐、估计肾小球滤过率、血红蛋白、白蛋白、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)与病理指标(球性硬化、血管壁增厚、间质炎性细胞浸润、系膜细胞增生程度、毛细血管内细胞增生程度、节段硬化程度与肾小管萎缩或间质纤维化程度)的差异,探讨吸烟对原发性IgA肾病患者临床及病理指标的影响。结果:1.共324例IgA肾病患者,吸烟者43例,占13.27%,且吸烟者均为男性患者,非吸烟组共281例,占86.73%。2.IgA肾病患者中,吸烟组的年龄、收缩压、舒张压、24h尿蛋白的水平明显高于非吸烟组,e GFR的水平明显低于非吸烟组,P0.05,差异有统计学意义。通过对eGFR进行pearson相关分析,发现eGFR与吸烟、年龄、收缩压、舒张压及24h尿蛋白定量呈显著负相关(r=-0.225,P=0.000;r=-0.359,P=0.000;r=-0.429,P=0.000;r=-0.406,P=0.000;r=-0.345,P=0.000);eGFR与球性硬化、间质炎性细胞浸润、肾小管萎缩及间质纤维化呈显著负相关(ρ=-0.464,P=0.000;ρ=-0.473,P=0.000;ρ=-0.585,P=0.000;ρ=-0.526,P=0.000)。通过多重线性回归进一步分析吸烟与eGFR的相关性,控制年龄、血压、24小时尿蛋白、球性硬化、间质炎细胞浸润、肾小管萎缩及间质纤维化可能的混杂因素后,发现吸烟与eGFR呈独立负相关(P0.05)。结果提示吸烟可能是加速IgA肾病患者e GFR下降的重要危险因素,推测吸烟比不吸烟更容易引起肾功能损害。3.在肾脏病理水平,IgA肾病患者吸烟组球性硬化程度、间质炎细胞浸润、间质纤维化/肾小管萎缩明显高于非吸烟(P=0.034;P=0.004;P=0.024),差异有统计学意义。通过对吸烟与病理指标进行Spearman相关分析,发现吸烟与球性硬化、间质炎性细胞浸润、肾小管萎缩及间质纤维化呈显著正相关(ρ=0.120,P=0.031;ρ=0.158,P=0.004;ρ=0.145,P=0.009;ρ=0.161,P=0.004)。通过Logistic回归进一步分析吸烟对IgA肾病患者间质炎细胞浸润、肾间质纤维化/肾小管萎缩的作用,调整了年龄、血压、24小时尿蛋白可能的混杂因素,结果P值均大于0.05;因此,结果未提示吸烟与肾脏病理改变存在独立相关性。结论:1、吸烟是影响IgA肾病患者eGFR的重要因素,提示吸烟比不吸烟更易引起肾功能损害。2、未发现吸烟与IgA肾病患者的肾脏病理存在独立相关性。
[Abstract]:Objective: To investigate the effects of smoking on primary clinical and pathological characteristics of IgA nephropathy: selection of nephrology in our hospital for the first time after renal biopsy were diagnosed as IgA nephropathy patients 324 cases as the research object. According to smoking history were divided into smoking group and non smoking group. Clinical indicators of two groups of patients (gender, age, blood pressure, 24 hours urine protein, urea, creatinine, estimated glomerular filtration rate, hemoglobin, albumin, cholesterol, triglyceride, high density lipoprotein, low density lipoprotein) and pathological index (Global sclerosis, vascular wall thickening, interstitial infiltration of inflammatory cells, the proliferation of mesangial cells. Endocapillary cell hyperplasia degree, the degree of hardening and segmental renal tubular atrophy or interstitial fibrosis) differences, explore the influence of smoking on primary clinical and pathological characteristics of IgA nephropathy. Results: 1. a total of 324 cases of patients with IgA nephropathy, smoking In 43 cases, accounting for 13.27%, and smokers were male patients, non smoking group were 281 cases, accounting for 86.73%.2.IgA nephropathy patients, smoking age, systolic blood pressure, diastolic blood pressure, 24h urine protein levels were significantly higher than non smoker group, e GFR levels were significantly lower than non smoker group, P0.05, was statistically significant by Pearson correlation analysis. The difference of eGFR, eGFR and smoking, age, systolic blood pressure, diastolic blood pressure and 24h urinary protein was negatively correlated (r=-0.225, P=0.000; r=-0.359, P=0.000; r=-0.429, P=0.000; r=-0.406, P=0.000; r=-0.345, P=0.000; eGFR) and glomerulosclerosis, interstitial inflammatory cell infiltration., renal tubular atrophy and interstitial fibrosis were negatively correlated (P =-0.464, P =-0.473, P=0.000; P=0.000; P=0.000; P =-0.585, P =-0.526, P=0.000). Through multiple linear regression analysis further smoking associated with the eGFR, controlling for age, blood pressure, urinary protein in 24 hours, the ball Sclerosis, interstitial infiltration of inflammatory cells and fibrosis may be confounding factors of renal tubular atrophy and later found that smoking and eGFR were negatively correlated (P0.05). The results indicated that smoking may be an important risk in patients with IgA nephropathy e GFR accelerated decline factors, that smoking than non-smokers more easily cause renal damage in.3. the level of IgA in patients with renal pathology, smoking nephropathy group glomerulosclerosis, interstitial inflammatory cell infiltration, interstitial fibrosis and tubular atrophy was significantly higher than that of non smoking (P=0.034; P=0.004; P=0.024), the difference was statistically significant. Spearman correlation analysis was conducted through physical indicators of smoking and disease, smoking and glomerulosclerosis, interstitial inflammation infiltration of inflammatory cells, renal tubular atrophy and interstitial fibrosis were positively correlated (P =0.120, P =0.158, P=0.031; P=0.004; P=0.009; P =0.145, P =0.161, P=0.004). Through Logistic regression analysis of smoking on IgA nephropathy patients Those interstitial infiltration of inflammatory cells, the role of renal interstitial fibrosis / renal tubular atrophy, adjusting for age, blood pressure, 24 hour urine protein potentially confounding factors, the P values are greater than 0.05; therefore, the results did not reveal any independent association between smoking and renal pathological changes. Conclusion: 1. Smoking is an important factor affecting eGFR in patients with IgA nephropathy, suggesting that smoking causes renal damage.2 more often than not smoking, no smoking and renal pathology in IgA nephropathy patients were independently associated.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.31

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