70例原发性IgA肾病的临床与病理分析

发布时间：2018-04-22 21:17

本文选题：IgA肾病 + 临床特点　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:分析原发性IgA肾病发病时的一般情况、临床表现、病理特征等,探讨其临床表现与病理改变之间的相关性,为临床上选择治疗方案及改善预后提供理论依据。方法:2011年至2016年在吉林大学中日联谊医院肾内科住院病理诊断为IgA肾病并除外紫癜性肾炎等继发性肾损害患者共70例。回顾性分析本70例患者的临床资料和病理资料。按Lee病理氏分级方法对病理进行分级,分析IgAN临床特点及其与病理之间的关系。结果:1.发病年龄从15~70岁,平均年龄为33.54±11.62岁,发病高峰为20~40岁。其中男性37人,女性33人,男女比例约为1.12:1,男性发病平均年龄为33.72±11.80岁,女性发病平均年龄为33.35±11.60岁,从发病至确诊为IgA肾病病程最短4天,最长180个月。2.本研究结果显示在IgA肾病7种临床分型中,最常见的为无症状尿检异常型23例(32.86%),其次为高血压型18例(25.71%)、大量蛋白尿型17例(24.29%)、反复发作肉眼血尿型8例(11.43%)、单纯镜下血尿型2例(2.86%)、终末期肾病型1例(1.43%)。3.在70例患者中,最常见Lee氏病理分级III级,共28人(40.00%),其次IV级、II级,分别为17人(24.29%)、12人(17.14%),I级和V级所占比例最小,分别为6人(8.57%)、7人(10.00%)。免疫球蛋白沉积形式主要是IgA+Ig M+C3,共29例,占41.43%;其次为IgA+C3,共24例,占34.29%,免疫球蛋白A沉积强度以“+++”最多,共45例(64.29%),其次“++”有20例(28.57%),“+”4例(5.71%),“++++”1例(1.43%)。但免疫球蛋白沉积形式及IgA沉积强度与IgA肾病患者病理分级无相关性。4.无症状尿检异常型、反复发作肉眼血尿型患者的肾脏病理多集中在Lee氏III级及以下,而大量蛋白尿型、高血压型肾脏病理则主要集中于Lee氏III、IV级,但各临床分型与病理分级之间无相关性。5.不同Lee氏病理分级与实验室指标中肌酐、尿素氮、血清免疫球蛋白IgA、血白蛋白有差异性(P0.05)。在63例Lee氏Ⅳ级及以下的IgA肾病患者中,尿素氮、血肌酐水平随病理分级的增高而升高,但Lee氏V级患者的血肌酐反而较Lee氏IV级患者降低。血白蛋白在Lee氏病理Ⅱ级患者中最高,以后随着病理级别的增高,血白蛋白降低。血清免疫球蛋白A在Lee氏Ⅳ级患者中最高,Lee氏病理Ⅱ级患者中最低。6.70例IgA肾病患者发病时肾小球滤过率多≥60 ml/min/1.73m2,各Lee氏病理分级与肾小球滤过率组间比较无统计学意义(P0.05)。结论:1.70例IgA肾病中男性患者略多于女性患者,好发于青壮年,发病高峰为20~40岁。2.IgA肾病临床分型以无症状尿检异常型最常见,其次为高血压型和大量蛋白尿型,但各临床分型与病理改变轻重无相关性,因此对各种临床表现的患者,即使无症状尿检异常者,亦应尽早行肾穿刺活检,明确肾脏病理。3.肾脏免疫球蛋白沉积形式、IgA沉积强度与IgA肾病患者Lee氏病理分级无相关性。4.尽管不同Lee氏病理分级与肌酐、尿素氮有相关性,但其与肾小球滤过率之间并无显著性差异。因此发病时肾功能水平不能作为评估病理严重程度的指标。5.由于不同Lee氏病理分级患者的临床都可以表现为大量蛋白尿,但所占比例不均,所以不能以血白蛋白水平评估病理严重程度。
[Abstract]:Objective: to analyze the general situation, clinical manifestation and pathological features of primary IgA nephropathy, to explore the correlation between the clinical and pathological changes, and to provide a theoretical basis for the clinical selection and improvement of the prognosis. Methods: the pathological diagnosis of IgA kidney in the nephrology department of the Sino Japanese Friendship Hospital of Jilin University from 2011 to 2016 A total of 70 patients with secondary renal damage except purpura nephritis were analyzed. The clinical data and pathological data of the 70 cases were analyzed retrospectively. The pathology was classified according to the Lee pathological grading method. The clinical characteristics of IgAN and the relationship with the pathology were analyzed. Results: the age of 1. was from 15 ~70 years, the average age was 33.54 + 11.62 years old, and the incidence was higher. The peak was 20~40 years, of which there were 37 men and 33 women, with a male and female proportion of about 1.12:1, the average age of male was 33.72 + 11.80 years, the average age of the female was 33.35 + 11.60 years, the shortest 4 days from the onset of the disease to the diagnosis of IgA kidney disease, and the longest 180 months of the.2. study showed that the most common symptoms were asymptomatic of the 7 types of IgA nephropathy. There were 23 cases of abnormal urine examination (32.86%), followed by 18 cases of hypertension (25.71%), 17 cases of proteinuria (24.29%), 8 cases of recurrent spontaneous hematuria (11.43%), 2 cases of microscopic hematuria (2.86%), 1 cases of end-stage nephrosis (1.43%).3. in 70 patients, the most common Lee grade III grade, followed by IV, II, respectively. The proportion of people (24.29%), 12 (17.14%), I and V was the lowest, 6 (8.57%) and 7 (10%). The immunoglobulin deposition was mainly IgA+Ig M+C3, 29 cases, 41.43%, followed by IgA+C3, 24, and 34.29%, the immunoglobulin A deposition intensity was most, 45 cases (64.29%), followed by + +. 5.71%), "+ + + +" (+ + +) 1 cases (1.43%). But the immunoglobulin deposition and the IgA deposition intensity and the pathological classification of patients with IgA nephropathy have no correlation with.4. asymptomatic abnormal type. The renal pathology of the patients with repeated attacks of flesh and urine is mostly at the III level and below the Lee's level, while a large number of egg white urine and hypertensive renal pathology are mainly concentrated on Lee's. III, IV, but there was no correlation between the clinical classification and the pathological grade,.5. different Lee pathological grading and the laboratory index of creatinine, urea nitrogen, serum immunoglobulin IgA, serum albumin (P0.05). In 63 cases of IgA nephropathy patients with Lee IV grade and below, the level of urinary nitrogen and serum creatinine increased with the increase of pathological grade, but Lee Serum creatinine in patients with grade V is lower than that of Lee IV patients. Serum albumin is the highest in Lee's pathological grade II patients. With the increase of pathological grade, serum albumin decreases. Serum immunoglobulin A is the highest in Lee's grade IV patients. The lowest glomerular filtration rate in the lowest.6.70 case of IgA nephropathy in Lee's pathological grade II patients. There was no significant difference between 60 ml/min/1.73m2 and Lee's pathological grading and glomerular filtration rate (P0.05). Conclusion: in 1.70 cases of IgA nephropathy, the male patients were slightly more than those of the female patients. The peak of the incidence was the 20~40 year old.2.IgA nephropathy, which was the most common type of asymptomatic urinary anomaly type, followed by hypertension and large amounts of protein. There is no correlation between the types of urine and the severity of the pathological changes. Therefore, in patients with various clinical manifestations, even if the asymptomatic urine samples are abnormal, early renal biopsy should be done to determine the renal pathological.3. renal immunoglobulin deposition, the IgA deposition intensity is not related to the Lee pathological grade of IgA nephropathy patients,.4. although different Lee's Histopathological grading is associated with creatinine and urea nitrogen, but there is no significant difference between the glomerular filtration rate and the glomerular filtration rate. Therefore, the renal function level can not be used as an indicator of the pathological severity of the disease.5. because of the clinical manifestations of different Lee's pathological grading patients with a large number of egg white urine, but the proportion is uneven, so it can not be white. The protein level was used to evaluate the pathological severity.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.31

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