IgA肾病血管病变与预后不良因素的相关性分析

发布时间：2018-03-28 21:25

本文选题：IgA肾病　切入点：肾血管病变　出处：《宁夏医科大学》2014年硕士论文

【摘要】：目的探讨IgA肾病（IgAN）肾血管病变与预后不良因素的相关性。方法将100例经肾活检确诊的原发性IgAN患者分为肾血管病变组和无血管病变组，进行对照研究，比较两组临床指标、病理改变的差异，探讨各临床指标、病理变化与血管病变之间的关系。结果100例IgAN患者中有肾血管病变者70例，占70%，，就本研究所观察到的肾血管病变特点及结合IgAN的病理改变，将血管病变分为3型：动脉玻璃样变型，动脉硬化型，动脉内膜增厚型，其发生率所占百分比分别为47.1%、28.6%、24.3%。无肾血管病变者30例，占30%。与无肾血管病变组相比，肾血管病变组单因素分析结果表明，高血压发生率、24h尿蛋白、血肌酐、血尿酸升高、血白蛋白降低均高于无肾血管病变组（P＜0.05）；病理学检查中肾小球硬化、肾间质纤维化、新月体形成、炎性细胞浸润病理表现发生率明显高于无肾血管病变组（P＜0.05）。多因素非条件logistic回归分析结果表明，高血压[OR=7.728，95%CI（1.708-34.964）]、24h尿蛋白定量[OR=20.022,95%CI(3.869103.623)]、肾小球硬化[OR=12.093,95%CI(2.43160.149)]、肾间质纤维化[OR=8.511,95%CI(1.33254.396)]，说明以上4个预后不良因素与IgAN肾血管病变成正性相关。结论IgAN预后不良因素：高血压、大量蛋白尿、肾小球硬化、肾间质纤维化与IgAN肾血管病变密切相关，进一步推断肾血管病变可作为判断预后的一项重要病理指标。
[Abstract]:Objective to investigate the correlation between renal vascular disease and poor prognosis in patients with IgA nephropathy. Methods 100 patients with primary IgAN diagnosed by renal biopsy were divided into two groups: renal vascular lesion group and non-vascular lesion group, and the clinical indexes were compared between the two groups. Results there were 70 cases (70%) with renal vascular lesions in 100 cases of IgAN. The characteristics of renal vascular lesions and the pathological changes combined with IgAN were observed in this study. The vascular lesions were divided into three types: glassy type, atherosclerosis type and intimal thickening type. The incidence of vascular lesions was 47.1% and 28.6%, respectively. 30 cases (30%) had no renal vascular lesions, which were compared with those without renal vascular lesions. The results of univariate analysis showed that the incidence of hypertension in 24 hours urine protein, serum creatinine, serum uric acid increased, serum albumin decreased than that in no renal vascular disease group (P < 0.05), glomerulosclerosis, renal interstitial fibrosis in pathological examination. The pathological features of crescents and inflammatory cell infiltration were significantly higher than those in the patients without renal vascular disease (P < 0.05). The results of multivariate conditional logistic regression analysis showed that: 1. Hypertension [OR7.728995 CIQ 1.708-34.964] 24 h urinary protein quantification [OR20. 022 + 95 CIQ 3.869 103.623], glomerulosclerosis [ORP 12.093 + 95CI2.43160.149], interstitial fibrosis [OR8.51195CI1 1.33254.396], indicating that the above four prognostic factors are positively related to IgAN renal angiopathy. Conclusion: hypertension, massive albuminuria, glomerulus, glomerulus, glomerulus, renal fibrosis, renal interstitial fibrosis (OR8.51195CI1.33254.396). Renal interstitial fibrosis is closely related to renal vascular lesions in IgAN.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.31

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