IgA肾病肾组织血管病变分析

发布时间：2018-04-25 09:11

本文选题：IgA肾病 + 肾组织血管病变　；参考：《郑州大学学报(医学版)》2015年05期

【摘要】：目的:分析IgA肾病肾组织血管病变与临床、病理改变及预后的关系。方法:选择肾活检确诊为原发性IgA肾病的1 699例患者,观察肾血管病变发生情况,分析患者临床病理改变及预后。终点事件定义为估计的肾小球滤过率(eGFR)下降50%(排除急性肾损伤)或患者进入透析。结果:1 699例中,1 010例(59.4%)有肾组织血管病变。与无血管病变组比较,有肾组织血管病变组高血压患者比例高(χ2=49.480,P0.001),活检时eGFR低(Z=1.720,P0.001),系膜细胞增生患者比例、球性硬化及新月体比例高(χ2=11.478,Z=17.072、7.011,P0.001),小管萎缩程度重(χ2=682.385,P0.001),随访期间eGFR下降速度更快(Z=2.763,P=0.006)。随访期间,有肾组织血管病变组发生肾脏终点事件249例,无血管病变组无终点事件发生,两组生存曲线差异有统计学意义(χ2=13.196,P0.001)。但Cox回归提示血管病变不是IgA肾病进入终点,事件的独立预测因子[HR(95%CI)=0.42(0.02~7.26)]。结论:肾组织血管病变在IgA肾病中普遍存在;存在肾组织血管病变的IgA肾病患者临床、病理损伤程度重,预后差。
[Abstract]:Objective: to analyze the relationship between renal vascular lesion and clinical, pathological changes and prognosis of IgA nephropathy. Methods: 1 699 patients with primary IgA nephropathy diagnosed by renal biopsy were selected to observe the occurrence of renal vascular disease and analyze the clinicopathological changes and prognosis of the patients. The endpoint event is defined as the estimated glomerular filtration rate (GFR) decreased by 50% (excluding acute renal injury) or the patient entered dialysis. Results of the 1699 cases, 1010 had renal vascular lesions. Compared with the non-vascular lesion group, the proportion of hypertensive patients with renal vascular lesions was higher (蠂 ~ 2 / 49.480 / P 0.001), the rate of eGFR was 1.720 / P _ (0.001), the proportion of Mesangial cell hyperplasia, the ratio of bulbar sclerosis and crescent body were higher (蠂 ~ 2 / 11.478Z _ (17.0727.011) P _ (0.001)), the atrophy of tubule was more severe (蠂 ~ 2 / 682.385U / P 0.001), and the eGFR decreased more rapidly during the follow-up period (2.763P _ (0.006)). During the follow-up period, there were 249 cases of renal end-point events in the patients with renal vascular lesions and no endpoint events in the non-vascular lesions group. The difference of survival curve between the two groups was statistically significant (蠂 ~ 2 ~ (2) 13.196) P 0.001 ~ (-1). However, Cox regression suggested that vascular disease was not an independent predictor of IgA nephropathy. Conclusion: renal vasculopathy is common in IgA nephropathy, and in IgA nephropathy patients with renal vascular disease, the degree of pathological injury is serious and the prognosis is poor.
【作者单位】：郑州大学第一附属医院肾脏内科;河南省高等学校临床医学重点学科开放实验室;
【分类号】：R692.31

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