有或无高血压的IgA肾病患者肾内小动脉病变的临床及病理意义

发布时间：2018-03-09 11:24

  本文选题：IgA肾病　切入点：肾内小动脉病变　出处：《首都医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：建立定量的IgA肾病小动脉病变评估标准，对高血压和正常血压的IgA肾病患者的小动脉病变进行临床及病理分析。 方法：①连续性纳入我科2010年3月至2013年10月期间肾活检病理示肾脏病变轻微的非IgA肾病患者50例作为正常对照人群，以等圆面积换算法（间接法）测定小动脉内、外直径，并计算每位患者全部测定小动脉的内外径比平均值，根据该值建立IgA肾病小动脉病变评估标准。②连续纳入我科同一时期行肾活检，病理诊断为IgA肾病的患者305例，根据①制定的标准，将其分为正常组、轻度病变组、重度病变组，对其临床指标（年龄、性别、收缩压、舒张压、SCr、UPr、UOP）和病理指标（IGS百分比）通过组间比较、单因素及多因素logistic回归进行分析。③对血压正常的IgA肾病患者147例，采用与②相同的方法进行小动脉病变的临床及病理分析。 结果：①正常对照人群的全部患者小动脉内直径/外直径平均值为0.52±0.05。IgA肾病小动脉病变评价标准为：内外径比值＞0.48为正常范围，0.45～0.48为轻度病变，≤0.45为重度病变。②IgA肾病患者小动脉病变发生率为36.4%，重度病变患者占全部的13.3%。与正常组相比，轻、重度病变组的收缩压、舒张压、SCr、IGS百分比均显著升高（P＜0.05），而UOP显著降低（P＜0.05）。重度病变组的舒张压、SCr及IGS百分比显著高于轻度病变组，UOP低于轻度病变组，虽无显著性差异，但有降低趋势。多因素logistic回归分析示：收缩压、SCr、UOP、IGS百分比与IgA肾病肾内小动脉病变程度独立相关。③血压正常的IgA肾病患者小动脉病变发生率为26.5%，重度病变患者占7.5%，与管壁正常组比较，，管壁轻、重度病变组的SCr及IGS百分比均显著升高（P＜0.05），UOP均降低，其中重度病变组差异有显著性（P＜0.05）。而轻、重度病变组相互比较，后者的SCr较前者显著增高，UOP显著降低（P＜0.05）。UOP、IGS百分比与血压正常的IgA肾病肾内小动脉病变程度独立相关。 结论：本研究采用间接法测定肾内小动脉病变程度，通过对小动脉正常患者的研究，建立起小动脉病变程度评价标准。将该标准应用于IgA肾病患者，发现肾内小动脉病变可以出现在血压正常及高血压的IgA肾病患者中，并且随着小动脉病变的加重患者常常出现更为严重的肾小球及肾小管损伤。
[Abstract]:Objective: to establish a quantitative evaluation standard for arteriolar lesions of IgA nephropathy and to analyze the clinical and pathological features of arteriolar lesions in patients with hypertension and normotensive IgA nephropathy. Methods from March 2010 to October 2013, 50 cases of non IgA nephropathy with mild renal lesions were included as normal controls. The internal and external diameters of arterioles were measured by equal circle area conversion method (indirect method). The mean ratio of internal and external diameter of arterioles was calculated. According to this value, the evaluation standard of arteriolar lesions of IgA nephropathy was established, which was included in renal biopsy in the same period of time in our department. 305 patients with IgA nephropathy were diagnosed by pathology. According to the established criteria, they were divided into normal group, mild lesion group and severe lesion group. The clinical indexes (age, sex, systolic blood pressure, diastolic blood pressure (SCR) UPrU UOPP) and pathological index (IGS percentage) were compared among groups. Univariate and multivariate logistic regression was used to analyze the clinical and pathological changes of arterioles in 147 IgA nephropathy patients with normal blood pressure. Results the mean internal and external diameter of arterioles was 0.52 卤0.05.IgA nephropathy in the normal control group. The evaluation criteria were as follows: the ratio of internal and external diameter > 0.48 was normal, 0.45 and 0.48 were mild lesions. The incidence of arteriopathy in patients with IgA nephropathy 鈮

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