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目的:研究IgA肾病患者的动态血压特征,及其肾脏组织病理学改变与动态血压间的联系。方法:研究人员根据病史资料收集IgA肾病患者的一般临床资料;利用光学显微镜观察患者肾活检标本,并根据牛津分级标准对肾脏组织病理学指标进行分级;利用携带式的动态血压检测仪收集患者动态血压。结果:本研究共纳入54例非透析IgA肾病患者。与CKD1期的IgA肾病患者相比,CKD4、5期IgA肾病患者的24 hSBP、dSBP、nSBP均升高,且差异具有统计学意义(P<0.05),而24 hDBP、dDBP、nDBP无明显变化。M0与M1组患者的24 h动态血压无明显改变;与E0组患者相比,E1组患者的24 hSBP、dSBP、nSBP均升高,且差异具有统计学意义(P<0.05),而24 hDBP、dDBP、nDBP无明显改变;S0与S1组患者的24 h动态血压无明显改变;与T0组患者相比,T1/T2组患者24 hSBP、24 hDBP、dSBP、dDBP、nSBP、nDBP均升高,且差异具有统计学意义(P<0.05)。结论:IgA肾病患者的24 h收缩压随着肾功能水平的下降而升高;肾小球毛细血管内皮细胞增生可能与24 h收缩压升高有关,肾间质纤维化/肾小管萎缩可能与24 h收缩压及24 h舒张压升高均有关。
Objective: To study the characteristics of ambulatory blood pressure (IgA) in patients with IgA nephropathy and the relationship between their pathological changes in renal tissues and ambulatory blood pressure. Methods: The researchers collected general clinical data of patients with IgA nephropathy according to medical history data. The patients’ renal biopsy specimens were observed under optical microscope. The histopathological parameters of kidney were graded according to the Oxford grading standards. The dynamic state of the patients blood pressure. Results: A total of 54 non-dialysis IgA nephropathy patients were enrolled in this study. Compared with CKD1 patients with IgA nephropathy, 24 hSBP, dSBP and nSBP in stage4,4 and 6 patients with IgA nephropathy were significantly increased (P <0.05), while there was no significant difference in 24 h DBP, dDBP and nDBP . There was no significant change in 24-h ambulatory blood pressure in M0 and M1 patients. Compared with E0 patients, the levels of 24 hSBP, dSBP and nSBP in patients in E1 group were significantly increased (P <0.05) , No significant changes in dDBP, nDBP; S0 and S1 patients 24 h ambulatory blood pressure had no significant change; compared with T0 patients, T1 / T2 patients 24 hSBP, 24 hDBP, dSBP, dDBP, nSBP, nDBP were increased , And the difference was statistically significant (P <0.05). CONCLUSIONS: Systolic blood pressure at 24 h in patients with IgA nephropathy increases with decreasing renal function. Proliferation of glomerular capillary endothelial cells may be related to an increase in systolic blood pressure at 24 h. Renal interstitial fibrosis / tubular atrophy may be associated with 24 h systolic blood pressure and 24 h diastolic blood pressure are related.