目的

探讨良性高血压肾小动脉硬化症（BHN）患者的临床病理特点及血压对患者临床与病理检测指标的影响。

方法

回顾性分析1995年1月至2011年12月解放军总医院肾脏病科收治的48例经肾活检确诊的BHN患者临床资料，包括患者的年龄、血压以及实验室检查指标，病理资料采用半定量方法评价，分析肾小球病变、肾小管间质病变（包括间质炎细胞浸润、间质纤维化、肾小管萎缩）、肾小动脉病变（肾小动脉狭窄和肾小动脉透明变性）特点。采用Spearman等级相关分析法分析血压与临床病理指标的相关性，logistic回归法分析临床及病理改变的联系，多组间检测指标的比较采用单因素方差分析。

结果

BHN患者男女比例为3.8∶1.0，平均年龄（46.56±9.59）岁，入院时血压 ＞ 140/90 mm Hg（1 mm Hg = 0.133 kPa）的患者33例（68.7%），尿蛋白定量＜ 1 g/24 h的患者26例（54.1%），估算的肾小球滤过率（eGFR） ＜ 60 ml/(min . 1.73 m²)的患者24例（50.0%）。对全部肾小动脉进行分析，其中肌内膜肥厚狭窄肾小动脉100条（22.8%），透明变性肾小动脉89条（19.2%）。缺血性病变是肾小球病变最常见表现，共293个（32.9%），包括废弃性硬化180个（20.2%），缺血皱缩肾小球113个（12.7%）。收缩压与肌内膜肥厚狭窄肾小动脉数量（r = 0.35，P = 0.02）、肾小管间质病变程度（r = 0.295，P = 0.04）呈显著正相关，而与eGFR（r = - 0.333，P = 0.021）呈显著负相关；蛋白尿是导致球性硬化肾小球的独立影响因素（OR = 5.12，P = 0.04）。未发现代谢因素对肾脏病理改变的影响。

结论

BHN患者肾小球病变的最常见类型为缺血性病变；患者血压水平升高导致肌内膜肥厚狭窄肾小动脉数量增加，同时引起eGFR下降；蛋白尿是球性硬化肾小球增多的独立影响因素。控制血压、减少蛋白尿是防治高血压肾病的关键。

Objective

To analyze the clinical and pathological features of benign hypertensive nephrosclerosis (BHN), and to clarify the influence of blood pressure to clinical and pathological parameters on BHN.

Methods

Forty-eight patients diagnosesed as benign hypertensive nephrosclerosis proved by renal biopsy were retrospectively analyzed from 1995 to 2011 in our hospital. The clinical data included the age, blood presser and laboratory test indicators, and pathological data were measured by semi-quantitative, analyze the features of glomerular lesions, tubulointerstitial lesions (including interstitial inflammatory cell infiltration, interstitial fibrosis and tubular atrophy), and renal arterioles lesions (hyalinization, the endomysium hypertrophy). The features of renal arterioles, glomeruli and tubulointerstitial lesions were analyzed. Spearman rank correlation is used to analyze the correlation between the blood pressure and the clinical pathological data. Logistic regression is used to analyze the relationship between the clinical and pathological data. One-way ANOVA is used to compare differences among multi groups. SPSS17.0 software is used to take all statistical analysis. The correlation between blood pressure level and clinical or pathological parameters were analyzed.

Results

The ratio of male to female was 3.8∶1.0, and the average age was (46.56±9.59) years. Thirty-three patients (68.7%) showed blood pressure ＞ 140/90 mm Hg(1 mm Hg = 0.133 kPa), and 26 (54.1%) disclosed urinary protein excretion ＜ 1 g/24 h. 24 patients (50.0%) had eGFR ＜ 60 ml/(min . 1.73 m²) at the time of admission.Number of myointimal hypertrophy arterioles was 100 (22.8%), and that of arterioles hyalinization was 84(19.2%). Ischemic lesions was the most common type of glomeruli damage, and the number is 293 (32.9%)including 180 obsolescent glomeruli (20.20%) and 113 ischemic wrinkled glomeruli (12.7%). Systolic blood pressure showed significant positive correlation with myointimal hypertrophy (r = 0.35, P = 0.02),tubulointerstitial lesion (r = 0.295, P = 0.04), but showed significant negative relation with eGFR (r =- 0.333, P = 0.021). Proteinuria was an independent influence factor for global sclerosis. Metabolic disorders had no influences on pathological changes.

Conclusions

Ischemic lesion was the most common type of glomerular damage. Percentage of myointimal hypertrophy increased and eGFR decreased as a result of hypertension, and proteinuria was an independent risk factor for global sclerosis. These results suggested that blood pressure control and reduction of proteinuria were the key for prevention and treatment of BHN.