Objective To compare the differences in clinicopathologic characteristics and prognosis between elderly and non-elderly patients with IgA nephropathy,and to explore the clinical and pathological characteristics of elderly patients with IgA nephropathy.Methods One hundred and fiftyseven patients with primary IgA nephropathy diagnosed by renal biopsy in the First Affiliated Hospital of China Medical University between January 2009 and December 2016 were enrolled in this study.Seventy-seven patients at the age of 60 years old and above were included as the elderly group,and 80 patients at the age between 14 and 59 were included as the control group.The clinical and pathological data of the included patients were collected,and comparison of the means between the groups was performed using Mann-Whitney U test.Results T he elderly group had a higher incidence of hypertension and higher levels of urinary protein excretion (hypertension:77.92％ vs.36.25％,P＜0.001;urinary protein excretion:3.08 ± 2.92 g/day vs.2.03 ± 1.91 g/day,P =0.009),lower levels of estimated glomerular filtration rates (eGFR),hemoglobin,serum albumin (eGFR:58.73 ± 28.29 ml · min-1 ·(1.73 m2)-1 vs.86.02±36.68 ml·min-1 ·(1.73 m2)-1,P＜0.001;hemoglobin:122.18± 18.79 g/L vs.130.41 ± 21.27 g/L,P =0.011;serum albumin:32.75 ± 7.89 g/L vs.37.26 ± 6.41 g/L,P＜0.001) than in the non-elderly group.On the pathological lesions,the elderly group had lower ratio of global and all categories of glomerulosclerosis (global sclerosis:0.17 ± 0.17 vs.0.25 ± 0.26,P =0.014;all categories of glomerulosclerosis:0.18 ± 0.18 vs.0.30 ± 0.29,P =0.003),more severe tubular-interstitial injury (expressed as the ratio of T0/T1,2) (0.75 vs.1.29,P＜0.001),a higher ratio of the glomeruli with crescents formation and a higher incidence of renal arteriole sclerosis (crescents formation:0.11 ± 0.23 vs.0.05 ± 0.05,P =0.049;arteriole sclerosis:87.01 ％ vs.37.5％,P＜0.001) than in the non-elderly group.During the period of follow-up,the elderly group had a higher incidence of end-stage renal disease than in the non-elderly group (15.09％ vs.3.39％,P =0.045).Conclusions The elderly patients with IgA nephropathy had more severe clinical manifestations,tubular-interstitial injury and renal arteriole sclerosis,and poorer renal prognosis in the non-elderly patients.%目的 本研究拟比较老年人与非老年人原发性IgA肾病临床病理及预后的差异,探讨老年人原发性IgA肾病临床及病理特点.方法 选择2009年1月至2016年12月在中国医科大学附属第一医院肾内科住院并进行肾活检确诊为原发性IgA肾病的患者157例,其中年龄≥60岁患者77例设为观察组,年龄为14～59岁患者80例设为对照组.收集入选患者的临床及病理资料,组间均数比较采用Mann-Whitney U检验.结果 与对照组相比,观察组IgA肾病患者的高血压发生率和尿蛋白定量水平更高[高血压:77.92％比36.25％,P＜0.001;24h尿蛋白定量:(3.08±2.92) g/d比(2.03±1.91) g/d,P=0.009],而估算的肾小球滤过率、血红蛋白、血清白蛋白水平更低[估算的肾小球滤过率:(58.73±28.29) ml·min-1·(1.73 m2)1比(86.02±36.68) ml·min-1·(1.73m2)-1,P＜0.001;血红蛋白:(122.18±18.79) g/L比(130.41±21.27) g/L,P=0.011;血清白蛋白:(32.75±7.89) g/L比(37.26±6.41) g/L,P＜0.001].病理损害方面,观察组球性硬化和各种程度硬化的肾小球比例低于对照组患者(球性硬化:0.17±0.17比0.25±0.26,P=0.014;各种硬化:0.18±0.18比0.30±0.29,P=0.003),肾小管间质损害更重(以T0/T1,2比例表示,0.75/1.29,P＜0.001),新月体形成的小球比例和肾小动脉硬化发生率更高(新月体:0.11±0.23比0.05±0.05,P=0.049;肾小动脉硬化:87.01％比37.5％,P＜0.001).随访期间观察组终末期肾脏病发生率更高(15.09％比3.39％,P=0.045).结论 与非老年人原发性IgA肾病患者相比,老年人原发性IgA肾病患者临床表现、小管间质损害和肾小动脉硬化更重,肾脏预后更差.
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