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目的研究IgA肾病的临床及病理变化特点。方法回顾性分析2005年3月至2009年7月在沈阳军区总院肾内科住院接受肾活检并经免疫病理检查确诊为原发性IgA肾病211例患者的临床及病理资料。结果肉眼血尿发病率38.3%,镜下血尿+蛋白尿发病率45.9%。具有明确的黏膜感染病史者占9.4%,发病前有明确诱因的患者占37.8%。镜下血尿+蛋白尿组水肿发病率11.1%,高血压发病率17.9%,肾功能损害发病率7.2%。211例IgA肾病患者病理分级以IgA肾病Ⅲ级为主,占63.1%。肾小球病理损害评分、系膜增殖程度积分、球性硬化积分、血管病变积分均以蛋白尿组最高(P<0.05),球性硬化积分、肾小管-间质积分以镜下血尿+蛋白尿组最高(P<0.05),对单纯蛋白尿组进行多因素Logistic回归分析显示,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素(OR值分别17.063,27.927)。结论镜下血尿+蛋白尿组及单纯蛋白尿组临床及病理改变较重,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素。
Objective To study the clinical and pathological features of IgA nephropathy. Methods The clinical and pathological data of 211 patients with primary IgA nephropathy diagnosed as renal IgA nephropathy undergoing renal biopsy in hospital from January 2005 to July 2009 in Shenyang Military Region General Hospital were retrospectively analyzed. Results The incidence of gross hematuria was 38.3%, and the incidence of microscopic hematuria + proteinuria was 45.9%. Patients with a clear history of mucosal infection accounted for 9.4%, 37.8% had a clear incentive before the onset of the disease. Microscopic hematuria + proteinuria edema incidence of 11.1%, hypertension incidence of 17.9%, the incidence of renal damage was 7.2%. The pathological grade of 211 IgA nephropathy patients was grade Ⅲ with IgA nephropathy, accounting for 63.1%. Glomerular pathological damage score, mesangial proliferation score, sclerotic score, vascular disease score were the highest proteinuria group (P <0.05), sclerotic score, tubulointerstitial integral to microscopic hematuria + protein Multivariate Logistic regression analysis showed that serum triglyceride and hypertension were the risk factors for progression of proteinuria (OR = 17.063 and 27.927, respectively) . Conclusions The clinical and pathological changes of microscopic hematuria + albuminuria group and simple albuminuria group were severe. Serum triglyceride and hypertension were the risk factors for the progression of proteinuria group.