老年IgA肾病的临床病理特征和预后分析

目的:探讨老年IgA肾病(IgA nephropathy,IgAN)临床病理特征和预后.方法:选择肾活检确诊的年龄≥60岁的IgA肾病患者70例,与同期肾活检确诊的年龄<60岁的IgA肾病患者82例进行临床、病理及预后对比分析比较.结果:老年组与非老年组相比,收缩压(142.0±20.4)mmHg vs (124.2±16.9)mmnHg,1 mmHg=0.133 kPa]、舒张压(83.1 4±11.8)mmUg vs(78.9 4±12.3)millHg]、肾穿时血肌酐水平(172.7-1±125.8)μmol/L vs(94.4 4±42.5)μmol/L]、血胆固醇(5.7 4±1.6)mmoL/ vs (5.1±1.6)mmol/L]、24 h尿蛋白定量(3.4±2.9)g/d vs(1.8 4±2.O)g/d]、高血压的发生率(57.1%vs32.5%)、慢性肾疾病(chronic kidney disease,CKD)分期3～5期的比例(64.O%伪14.6%)差异均有统计学意义(P<0.05).两组的病程、肉眼血尿的发生率、血甘油三酯、血WgA水平差异无统计学意义(P>o.05).病理资料上,老年组肾病理以慢性化病变为主,与非老年组相比,肾小球硬化(19.7 4±20.1)%vs(13.4 4±17.8)%]、肾小管萎缩(>1分,34.2%vs25.6%)、间质纤维化(>1分,34.2%vs 18.2%)、肾小动脉硬化(>2分,20.O%vs 8.5%)的比例差异均有统计学意义(P<0.05).而系膜细胞增生、新月体比例、间质炎症细胞浸润在两组间差异无统计学意义(P>0.05).平均随访(34.6 4±33.3)个月,老年组3年和5年累计肾生存率显著低于非老年组(74.6%1.78 100%,62.2%vs92.9%,P=0.002).结论:老年组IgA肾病患者在确诊时高血压、肾功能不全、高脂 血症的发生率较高,肾脏病理改变以慢性病变为主,肾小动脉病变明显,这可能是导致老年IgA肾病患者预后差的原因.

Clinicopathologic characteristics and outcomes of IgA nephropathy in elder patients

OBJECTIVE:To investigate the clinical, pathological characteristics and outcomes of IgA nephropathy in the elderly. METHODSúSeventy patients over age 60 with IgA nephropathy were studied and compared with 82 patients under 60 years in the clinical and pathological features as well as the outcomes. RESULTSúCompared with non-elderly group, elder group patients had higher blood pressure systolic pressure (142.0+/-20.4) mmHg vs (124.2+/-16.9) mmHg (1mmHg=0.133 kPa), diastolic pressure (83.1+/-11.8) mmHg vs (78.9+/-12.3) mmHg], serum creatinine (172.7+/-125.8) mumol/L vs (94.4+/-42.5) mumol/L], serum cholesterol(5.7+/-1.6) mmol/L vs (5.1+/-1.6) mmol/L], 24 hj urinary protein excretion rate (3.4+/-2.9) g/d vs (1.8+/-2.0) g/d], and the incidence of CKD stages 3-5(64.0% vs 14.6%)(P<0.05). No significant differences were seen in the disease courses, rate of gross hematuria, serum triglyceride and serum IgA level between two groups(P>0.05).Renal pathojlogical investigation showed the chronic lesions were dominated in elder group. There was significant difference in portion of glomerular sclerosis (19.7+/-20.1)% vs (13.4+/-17.8)%], renal tubule atrophy (>1 score,34.2% vs 25.6%), interstitial fibrosis (>1,score 34.2% vs 18.2%), and arteriolosclerosis (>2 score,20.0% vs 8.5%) between two groups (P<0.05). However, there were no significant difference in proportion of mesangial proliferation, crescent and interstitial inflammatory cell infiltration (P>0.05). After a mean postjbiopsy followjup of (34.6+/-33.3) months, the 3-year and the 5-year renal survival rates for elder group were 74.6% and 62.2%, respectively, which were lower than those of nonjelder group (100% and 92.9%, P=0.002). CONCLUSIONúElder patients with IgA nephropathy were more likely to suffer from hypertension, hyperlipidemia, renal insufficiency and chronic pathologic lesions, which might be the risk factors for the patient's unfavorable prognosis.