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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2017, Vol. 06 ›› Issue (03) : 127 -131. doi: 10.3877/cma.j.issn.2095-3216.2017.03.007

所属专题： 文献；

论著

少量蛋白尿且无高血压的IgA肾病患者肾内小动脉玻璃样变相关因素分析
段姝伟1, 陈丁2, 吴杰1,†(), 刘述文1, 郑颖1, 谢院生1, 蔡广研1   
  1. 1. 100853　解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心
    2. 100089　北京，空军航空医学研究所附属医院
  • 收稿日期:2017-05-20 出版日期:2017-06-28
  • 通信作者: 吴杰
  • 基金资助:
    国家科技重大专项课题中药大品种技术改造与技术提升研究的子课题(2014ZX09201021-007); 北京市科委课题(Z161100000516225)

Correlation analysis of intrarenal arteriolar hyalinosis in IgA nephropathy with mild proteinuria and without hypertension

Shuwei Duan1, Ding Chen2, Jie Wu1,†(), Shuwen Liu1, Ying Zheng1, Yuansheng Xie1, Guangyan Cai1   

  1. 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases; Beijing 100853
    2. Affiliated Hospital of the PLA Aeromedicine Institute; Beijing 100089, China
  • Received:2017-05-20 Published:2017-06-28
  • Corresponding author: Jie Wu
  • About author:
    Corresponding author: Wu Jie, Email:
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段姝伟, 陈丁, 吴杰, 刘述文, 郑颖, 谢院生, 蔡广研. 少量蛋白尿且无高血压的IgA肾病患者肾内小动脉玻璃样变相关因素分析[J]. 中华肾病研究电子杂志, 2017, 06(03): 127-131.

Shuwei Duan, Ding Chen, Jie Wu, Shuwen Liu, Ying Zheng, Yuansheng Xie, Guangyan Cai. Correlation analysis of intrarenal arteriolar hyalinosis in IgA nephropathy with mild proteinuria and without hypertension[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2017, 06(03): 127-131.

目的

探索少量蛋白尿且无高血压的IgA肾病(IgAN)患者肾内小动脉玻璃样变(AH)相关因素。

方法

回顾性分析2010年1月1日至2014年12月31日在解放军总医院经肾穿刺活检、尿蛋白定量平均水平≤1 g/d且无高血压病史的原发性IgAN患者，采集患者肾穿刺活检前1周内的14项临床指标包括体质量指数、血压等，肾活检后的病理指标按照IgAN牛津分型更新版评价，根据是否伴有肾内AH病变将患者分为两组，比较组间临床、病理指标的差异，并采用logistic回归分析肾内AH病变相关因素。

结果

共纳入IgAN患者126例，其中伴有肾内AH病变的患者44例(34.92%)。伴肾内AH组患者的年龄、体质量指数、血尿酸、尿素氮、血肌酐水平均高于无肾内AH组患者，eGFR低于无肾内AH组患者(P均<0.05)，慢性肾脏病分期和小管萎缩/间质纤维化病变在两组间分布也有差异(z＝3.290, P＝0.001; z＝3.293, P＝0.001)。多元logistic回归分析显示IgAN患者肾内AH病变相关因素有男性(OR 3.08，95%CI 1.03～9.18)、年龄每增加10岁(OR 3.02，95%CI 1.79～5.07)、体质量指数每增加10 kg/m2(OR 7.08，95%CI 1.54～32.42)和肾小管萎缩/间质纤维化病变(OR 5.96，95%CI 2.11～16.80)。

结论

蛋白尿少于≤1 g/d且无高血压的IgAN患者中发生肾内AH病变并不少见。男性、增龄、超重和肾小管萎缩/间质纤维化病变是此组IgAN患者肾内AH病变的相关因素。

关键词: IgA肾病, 肾内小动脉玻璃样变, 病理
Objective

To explore the correlation of intrarenal arteriolar hyalinosis (AH) with clinical and pathological indicators in IgA nephropathy (IgAN) with mild proteinuria and without hypertension.

Methods

Retrospective analysis was performed in patients with newly biopsy-confirmed IgAN between January 1, 2010 and December 31, 2014 in the Department of Nephrology, Chinese PLA General Hospital. The patients′ clinical data during the week before renal biopsy were collected. Pathological lesions were evaluated according to the updated Oxford Classification. Patients were divided into intrarenal AH group and non-AH group. Clinical and pathological indictors were compared between the two groups. The correlation of intrarenal AH with clinical and pathological indicators was analyzed using multivariant logistic regression method.

Results

A total of 126 IgAN cases without hypertension were enrolled, among whom 44 (34.92%) cases had intrarenal AH. All the 126 cases had proteinuria ≤1 g/d. The age, body mass index, serum uric acid, urea nitrogen, and creatinine were higher in intrarenal AH group than in non-AH group (P<0.05). And eGFR of intrarenal AH group was lower than that of non-AH group (P<0.05). There were significant differences in chronic kidney disease stages and tubular atrophy/interstitial fibrosis between the two groups (z=3.290, P=0.001; z=3.293, P=0.001). Multivariant logistic regression analysis showed that intrarenal AH of IgAN was correlated with male (OR 3.08, 95%CI 1.03-9.18), each age increase by 10 years (OR 3.02, 95%CI 1.79-5.07), each body mass index increase by 10 kg/m2 (OR 7.08, 95%CI 1.54-32.42), and tubular atrophy/interstitial fibrosis (OR 5.96, 95%CI 2.11-16.80).

Conclusion

It is not uncommon for IgAN patients with mild proteinuria and without hypertension to have intrarenal AH. Gender, age, body mass index, and tubular atrophy/interstitial fibrosis were correlated with intrarenal AH of IgAN.

Key words: IgA nephropathy, Intrarenal arteriolar hyalinosis, Pathology
表1 入组IgA肾病患者的临床特征[±s或例数(%)]
指标 无肾内AH组(n＝82) 有肾内AH组(n＝44) t值或χ2值 P值
年龄(岁) 33.73±9.76 41.95±9.15 4.605 <0.001
性别(男) 44(53.66) 31(70.45) 3.353 0.067
BMI(kg/m2) 23.82±3.60 25.96±3.03 3.346 0.001
收缩压(mmHg) 123.67±14.79 129.02±17.78 1.802 0.074
舒张压(mmHg) 79.11±10.61 82.25±13.32 1.446 0.151
平均动脉压(mmHg) 93.96±11.31 97.84±13.90 1.691 0.093
血尿酸(mmol/L) 358.29±105.34 406.51±96.89 2.518 0.013
血清白蛋白(g/L) 42.57±3.78 41.63±3.35 1.371 0.173
尿蛋白定量(g/d) 0.60±0.24 0.66±0.22 1.301 0.196
尿素氮(mmol/L) 5.05±1.93 6.42±2.38 3.489 0.001
肌酐(μmol/L) 85.70±34.96 105.03±37.48 2.884 0.005
eGFR[mL/(min ·1.73 m2)] 96.48±24.85 77.14±24.55 4.182 <0.001
甘油三酯(mmol/L) 1.54±0.89 1.85±0.83 1.887 0.062
总胆固醇(mmol/L) 4.20±0.80 4.48±0.73 1.915 0.058
CKD分期a ? ? 3.290 0.001
? 1期 55(67.07) 16(36.36) ? ?
? 2期 16(19.51) 16(36.36) ? ?
? 3a期 9(10.98) 7(15.91) ? ?
? 3b期 1(1.22) 4(9.09) ? ?
? 4期 1(1.22) 1(2.27) ? ?
表2 入组IgA肾病患者的病理特征[例数(%)]
组别 例数 M1a E1a S1 Tb C1 补体C3
T1 T2
无肾内AH组 82 10(12.20) 4(4.88) 50(60.98) 15(18.29) 2(2.44) 20(24.39) 14(58.33)
有肾内AH组 44 3(6.82) 2(4.55) 26(59.09) 15(34.09) 6(13.64) 5(11.36) 10(41.67)
χ2值或z值 － － － 0.042 3.293 3.055 0.594 ?
P值 － 0.267 0.651 0.837 0.001 0.080 0.441 ?
表3 入组IgA肾病患者肾内小动脉玻璃样变与临床、病理指标的单因素logistic回归分析
指标 参数估计值 OR(95%CI) Wald P值
年龄(每增加10岁) 0.85 2.34(1.55～3.54) 16.304 <0.001
男/女(1/0) 0.72 2.06(0.94～4.49) 3.299 0.069
BMI(每增加10 kg/m2) 1.83 6.24(1.97～19.80) 9.657 0.002
平均动脉压(每增加10 mmHg) 0.26 1.29(0.96～1.75) 2.766 0.096
尿素氮(mmol/L) 0.32 1.38(1.12～1.70) 8.935 0.003
血肌酐(每增加10 μmol/L) 0.15 1.16(1.04～1.31) 6.578 0.010
eGFR[每增加10 mL/ (min· 1.73 m2)] －0.30 0.74(0.64～0.87) 14.007 <0.001
血尿酸(每增加100 mmol/L) 0.45 1.57(1.08～2.27) 5.725 0.017
甘油三酯(mmol/L) 0.39 1.48(0.97～2.25) 3.263 0.071
总胆固醇(mmol/L) 0.46 1.59(0.98～2.57) 3.520 0.061
新月体病变 －0.92 0.40(0.14～1.15) 2.918 0.088
肾小管萎缩/间质纤维化病变a 1.25 3.49(1.57～7.75) 9.455 0.002
表4 入组IgA肾病患者肾内小动脉玻璃样变与临床、病理指标的多因素logistic回归分析
指标 参数估计值 OR(95%CI) Wald P值
男/女(1/0) 1.12 3.08(1.03～9.18) 4.070 0.044
年龄(每增加10岁) 1.10 3.02(1.79～5.07) 17.362 <0.001
BMI(每增加10 kg/m2) 1.96 7.08(1.54～32.42) 6.347 0.012
肾小管萎缩/间质纤维化病变a 1.78 5.96(2.11～16.80) 11.374 0.001
图1 肾小球入出球小动脉玻璃样变(PAS×400)
图2 肾间质小动脉玻璃样变伴肾小管萎缩(PAS×400)
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