原发性IgA肾病合并高尿酸血症临床及病理分析

发布时间：2018-06-15 10:00

  本文选题：高尿酸血症 + IgA肾病　； 参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的通过对临床和病理指标进行分析,探究原发性Ig A肾病出现高尿酸血症的病因及危害,为延缓IgA肾病进展提供临床指导依据。方法收集2015年1月至2016年12月期间在蚌埠医学院第一附属医院住院患者64例,经皮肾穿刺活检组织检查明确诊断为原发性Ig A肾病。根据血尿酸水平分为血尿酸正常组和高尿酸血症组。观察指标:性别、初次肾活检时年龄、病程、血压、血尿酸、血肌酐、血尿素氮、血浆白蛋白、血甘油三酯、血胆固醇、24小时尿蛋白定量、肾脏病理Lee氏分级。对上述资料进行统计学分析。结果1.本研究64例原发性Ig A肾病患者占肾穿刺总人数的31.4%,高尿酸血症在原发性Ig A肾病中的发病率为35.9%。2.本研究中,Ig A肾病患者高尿酸血症组有4例肾功能正常、19例肾功能异常,血尿酸正常组有26例肾功能正常、15例肾功能异常。高尿酸血症组与血尿酸正常组之间肾功能异常者与肾功能正常者所占比例差异有统计学意义(P0.05)。3.分别比较Ig A肾病患者高尿酸血症组与血尿酸正常组的病程、年龄、血胆固醇、血甘油三酯、血白蛋白,其差异均无统计学意义(P0.05),而两组间血肌酐、血尿素氮、24小时尿蛋白定量、血压的差异有统计学意义(P0.05)。4.高尿酸血症在Ig A肾病患者Lee氏分级II级、III级、IV级中的构成比分别为6.7%、44.4%、46.2%,II级、III级、IV级中高尿酸血症的构成比差异存在统计学意义(P0.05)。5.应用SPearman法分析Ig A肾病患者,其血尿酸水平与年龄、病程、血胆固醇、血甘油三酯、血浆白蛋白无相关性;与血尿素氮、24小时尿蛋白定量、Lee氏分级呈正相关,与e GFR呈负相关。e GFR与Lee氏分级呈负相关,血尿素氮、24小时尿蛋白定量分别与Lee氏分级呈正相关。6.经多因素Logistic回归分析显示:男性、高龄、高尿酸血症是原发性Ig A肾病的危险因素。结论1.原发性Ig A肾病并发高尿酸血症者较其他病理类型比例高。2.原发性Ig A肾病患者血尿酸水平与血尿素氮、24小时尿蛋白定量、Lee氏分级呈正性相关,与e GFR呈负性相关,应注意按时监测上述指标,以便及时发现原发性Ig A肾病有无进展。3.高尿酸血症是原发性Ig A肾病的显著危险因素,临床医生应控制Ig A肾病患者的血尿酸水平,并对患者进行宣教,这对治疗Ig A肾病和延缓肾脏疾病进展具有一定的指导意义。
[Abstract]:Objective to explore the etiology and harm of hyperuricemia in primary IgA nephropathy by analyzing the clinical and pathological indexes, and to provide clinical guidance for delaying the progression of IgA nephropathy. Methods from January 2015 to December 2016, 64 hospitalized patients in the first affiliated Hospital of Bengbu Medical College were selected and diagnosed as primary IgA nephropathy by percutaneous renal biopsy. According to the level of serum uric acid, it was divided into normal group and hyperuricemia group. Outcome measures: sex, age at first renal biopsy, course of disease, blood pressure, serum uric acid, serum creatinine, blood urea nitrogen, plasma albumin, serum triglyceride, serum cholesterol 24 hours urinary protein quantitative, renal pathological Lee's grade. The above data were analyzed statistically. Result 1. In this study, 64 patients with primary IgA nephropathy accounted for 31.4% of the total number of renal puncture. The incidence of hyperuricemia in primary IgA nephropathy was 35.90.2. In this study, there were 4 cases with normal renal function and 19 cases with abnormal renal function in hyperuricemia group and 26 cases with normal renal function in normal blood uric acid group. There was significant difference in the proportion of abnormal renal function and normal renal function between hyperuricemia group and normal blood uric acid group. The course, age, serum cholesterol, serum triglyceride and serum albumin of patients with hyperuricemia and normal serum uric acid in patients with IgA nephropathy were compared respectively. There was no significant difference in serum creatinine between the two groups. The blood urea nitrogen in 24 hours urine protein quantity, the blood pressure difference has the statistical significance (P 0.05. 4). The compositional ratios of hyperuricemia in patients with IgA nephropathy were 6.7in Lee's grade II and 44.42 in grade 鈪，

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