IgA肾病牛津分型与临床指标的相关性及危险因素分析

发布时间：2018-06-17 10:43

  本文选题：IgA肾病 + 牛津分型　； 参考：《中国医科大学学报》2017年01期

【摘要】：目的研究Ig A肾病牛津分型的4种主要病变:系膜细胞增生(M0/1)、内皮细胞增生(E0/1)、节段性硬化或粘连(S0/1)、肾小管萎缩或肾间质纤维化(T0/1/2)与临床指标之间的相关性及危险因素。方法收集2006年2月17日至2011年10月11日在中国医科大学附属第一医院肾内科经肾活检确诊的514例18岁以上Ig A肾病患者的临床及病理资料。除外过敏性紫癜、强直性脊柱炎、银屑病等继发性Ig A肾病。采用χ~2检验、Spearman秩相关、二分类及多因素logistic回归分析进行统计学分析。结果514例Ig A肾病患者中,男女比例1.06∶1,平均年龄(35.70±11.99)岁,平均病程(18.31±30.42)个月。单纯血尿组牛津分型以M0E0S0T0为主。慢性肾脏病肾功能分期、24 h尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿Ig G与M病变呈正相关;血清白蛋白、C3、血小板与M病变呈负相关。24 h尿蛋白定量和血小板升高是影响系膜细胞增生程度的独立危险因素。尿蛋白≥3.5 g的患者M1的比例(67.5%)显著高于非肾病范围蛋白尿的患者。年龄、收缩压、尿红细胞计数、24 h尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿Ig G与E病变呈正相关;病程、血清白蛋白与E病变呈负相关。年龄、病程长是E病变加重的独立危险因素。60岁以上患者E1的比例(73.3%)显著高于60岁以下患者。CKD分期、收缩压、24 h尿蛋白定量与S病变呈正相关。年龄、CKD肾功能分期、收缩压、舒张压、C4、甘油三酯、低密度脂蛋白、C反应蛋白、血清纤维蛋白原、血尿酸、血胱抑素C、24 h尿蛋白定量、尿β2微球蛋白、尿微量白蛋白、尿转铁蛋白、尿Ig G与T病变程度呈正相关,血红蛋白、血清白蛋白、血Ig G与T病变呈负相关。前驱感染史、舒张压≥90 mm Hg、低白蛋白血症、高低密度脂蛋白血症、贫血、高C反应蛋白血症是T病变加重的影响因素。结论24 h尿蛋白定量和血小板升高,高龄,病程长,存在低白蛋白血症、贫血、高脂血症、前驱感染、舒张压升高、高C反应蛋白血症是Ig A肾病患者牛津分型病变严重的危险因素,对存在上述因素的患者应及时行肾活检,明确病理分级,给予个体化治疗,以改善预后。
[Abstract]:Objective to study the correlation and risk factors between the four major pathological changes of IgA nephropathy: Mesangial cell proliferation (M0 / 1), endothelial cell proliferation (E0 / 1 / 1), segmental sclerosis or adhesion (S0 / 1), tubular atrophy or renal interstitial fibrosis (T0 / 1 / 2). Methods from February 17, 2006 to October 11, 2011, the clinical and pathological data of 514 patients with IgA nephropathy over 18 years old diagnosed by renal biopsy in the first affiliated Hospital of China Medical University were collected. Except allergic purpura, ankylosing spondylitis, psoriasis and other secondary IgA nephropathy. 蠂 ~ 2 test was used to analyze Spearman's rank correlation, two-classification and multivariate logistic regression analysis. Results in 514 patients with IgA nephropathy, the ratio of male to female was 1.06: 1, with an average age of 35.70 卤11.99 years and an average course of 18.31 卤30.42 months. In simple hematuria group, the main Oxford typing was M0E0S0T0. There was a positive correlation between urinary microalbuminuria, urinary transferrin, urinary IgG and M lesion. Serum albumin C _ 3, platelet and M lesion were negatively correlated. 24 h urinary protein quantification and platelet elevation were independent risk factors for the degree of Mesangial cell proliferation. The proportion of M1 in patients with urinary protein 鈮，

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