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目的:分析银屑病相关性IgA肾病(IgAN)的临床表现、免疫学特点和肾脏病理特点。方法:回顾性分析解放军肾脏病研究所2001年11月至2007年2月诊断为银屑病相关性IgAN共20例患者,分析其临床表现、实验室指标、肾脏病理特点。结果:(1)年轻男性多见,男性15例,女性5例。平均年龄18~54(31.9±10.7)岁。(2)20例患者均为寻常型银屑病。平均银屑病病程为1~26(8.7±6.2)年,其中12例肾脏损害出现在皮疹稳定期,8例出现在皮疹活动期。(3)在银屑病发病后平均2~306(95.0±71.1)月发现肾脏损害,其平均病程为0.3~36(8.73±9.56月)。4例以水肿、大量蛋白尿、高血压起病,16例起病表现为无症状镜下血尿和(或)蛋白尿。2例患者病史中曾出现发作性肉眼血尿。(4)免疫系统异常。3例患者血清IgA水平轻度升高,9例可见补体C3轻度降低。(5)13例患者肾脏病理表现为肾小球节段性瘢痕形成,7例为轻到中度肾小球系膜细胞增生和系膜基质增多,3例可见节段袢坏死,5例存在纤维细胞性新月体。6例小管间质慢性化病变明显。8例可见明显间质浸润细胞多处小灶性分布,以单个核细胞为主,较多浆细胞和中性粒细胞。13例可见间质血管病变。结论:银屑病相关性IgAN多见于年轻男性,临床主要表现为尿检异常或肾病综合征,肾脏组织学改变可有多种表现。
Objective: To analyze the clinical manifestations, immunological characteristics and renal pathological features of IgAN associated with psoriasis. Methods: A retrospective analysis of the PLA Renal Disease Institute from November 2001 to February 2007 diagnosed with psoriasis-related IgAN in 20 patients, analysis of its clinical manifestations, laboratory parameters, renal pathological features. Results: (1) Young men were more common, 15 males and 5 females. The average age ranged from 18 to 54 (31.9 ± 10.7) years. (2) All 20 patients were psoriasis vulgaris. The mean duration of psoriasis was 1 to 26 (8.7 ± 6.2) years, of which 12 were renal damage at stable stage and 8 at rash stage. (3) On average, 2 ~ 306 (95.0 ± 71.1) months after onset of psoriasis, kidney damage was found. The average course of disease was 0.3 ~ 36 (8.33 ± 9.56 months). 4 cases with edema, a large number of proteinuria, hypertension onset, onset of 16 cases showed asymptomatic microscopic hematuria and (or) proteinuria. Two patients had a history of episodes of gross hematuria. (4) Immune system abnormalities. Serum IgA levels were slightly elevated in 3 patients, while complement C3 was slightly decreased in 9 patients. (5) Thirteen patients had renal pathological appearance of segmental glomerular glomerular sclerosis, 7 cases of mild to moderate glomerular mesangial cell proliferation and mesangial matrix increased, three cases showed segmental necrosis, and 5 cases Fibrocystic crescent. 6 cases of tubulointerstitial lesions significantly. In 8 cases, multiple interstitial infiltrating cells were found to be characterized by multiple focal distributions, mainly mononuclear cells, and more plasma cells and neutrophils. 13 cases of interstitial vascular lesions can be seen. CONCLUSIONS: Psoriasis-associated IgAN is more common in young males. The main clinical manifestations are abnormal urinalysis or nephrotic syndrome. Renal histological changes may have multiple manifestations.