192例IgA肾病临床与牛津病理分型的分析

摘要

目的 探讨IgA肾病患者的临床表现与牛津病理分型的相关性.方法 分析192例IgA肾病患者的临床表现(年龄、性别、病程、血压、血尿、24 h尿蛋白定量、血肌酐、血清白蛋白、甘油三酯、胆固醇、估计肾小球滤过率(eGFR))与病理资料(系膜细胞增生、内皮细胞增生、节段硬化或粘连、肾小管萎缩或间质纤维化、小动脉积分、细胞或细胞纤维新月体)的相关性.结果 (1)192例IgA肾病患者临床表现以蛋白尿合并血尿最多见,为72例(37.5％),依次为肾病综合征42例(21.9％),肾功能不全29例(15.1％),合并高血压72例(37.5％)；(2)牛津病理分型中M1占60.0％,E1占55.2％,S1占46.9％,T0、T1、T2分别占59.9％、22.9％、17.2％,46.9％的患者存在小动脉内膜增厚,48.5％存在细胞或细胞纤维新月体,部分病理类型与年龄有关(P＜0.01)；(3)尿蛋白定量与系膜细胞增生、肾小管萎缩或间质纤维化、细胞或细胞纤维新月体有关(P ＜0.01或P＜0.05).血压、肾功与节段硬化或粘连、肾小管萎缩或间质纤维化、小动脉内膜增厚、细胞或细胞纤维月体有关(P＜0.01或P＜0.05).结论 牛津病理分型对IgA肾病的治疗和预后评价有很好的指导作用.%Objective To investigate the relationship of the clinical characteristics and the Oxford classification of IgA nephropathy.Methods Clinical presentation (age,gender,course of disease,blood pressure,hematuria,24-hour proteinuria,serum creatinine,serum albumin,triglyceride,cholesterol,and estimated glomerular filtration rate (eGFR)),pathological data (mesangial hypercellularity,endocapillary hypercellularity,segmental sclerosis or adhesions,tubular atrophy or interstitial fibrosis,artery score,and cellular + fiberocellular crescents) and their correlation of 192 patients with IgA nephropathy patients were analyzed.Results (1)Clinically,hematuria + albuminuria type was the most common among 192 the patients with IgA nephropathy (72 cases,37.5％) followed by nephrotic syndrome (42 cases,21.9％),renal insufficiency (29 cases,15.1％),hypertension (72 cases,37.5％).(2)M1 was 60.0％,E1 was 55.2％,S1 was 46.9％,T0,T1,T2 were 59.9％,22.9％,and 17.2％,respectively,small artery thickening was 46.9％,patients with cellular + fiberocellular crescents wais 48.5％.Some pathology features were related to age.(3)Proteinuria was associated with the mesangial hypercellularity score,endocapillary hypercellularity,segmental sclerosis or adhesions,and tubular atrophy or interstitial fibrosis and cellular + fiberocellular crescents.Blood pressure and renal function were associated with segmental sclerosis or adhesions,tubular atrophy or interstitial fibrosis,small artery thickening and cellular + fiberocellular crescents.Conclusions The Oxford classification has a good clinical guide of treatment and prognosis of IgA nephropathy.