IgA肾病伴肾功能进展患者肾脏病理学特点

目的 探讨lgA肾病患者慢性肾功能进展的病理风险因素.方法 随访309例lgA肾病患者,随访期内,按是否肌酐倍增或进入终末期肾病,将患者分为肾功能稳定组(253例)和肾功能进展组(56例),对比2组患者肾脏病理资料.结果 ①免疫荧光:2组患者相比较,IgA、IgM等各类免疫病理沉积物半定量均无统计学意义(P均＞0.05).②病理评分:除血管指数外,余肾脏病理评分指标如肾小球指数、硬化指数、新月体指数和问质指数在肾功能进展组显著增高(P均＜0.05).③回归分析:以肾穿刺时的SCr水平为因变量,与病理评分指标作直线逐步回归分析,相关密切的分别是硬化指数、新月体数和间质指数(P均＜0.05).结论 免疫沉积物的种类或数量可能和肾功能是否进展不相关;较重的肾小球增生硬化、新月体形成和间质改变可能是肾功能进展的病理风险因素.

Pathological characteristics of progressive IgA nephropathy

Objective To investigate pathological risk factors of progressive IgA nephropathy.Methods 309 cases of IgA nephropathy were followed,and stable(n=253)or progression group(n=56)was decided by setum creatinine level whether Was doubling or into end stage renal by the end of following up.Results ①No significant differences were detected in each immunocomplex semiquantitative scores between the two groups(P＞0.05 for each).②Except vaso-index,others like glomerular index,sclero-index,crescentic index and interstitial index were higher in the patients of progressive group(P＜0.05 for each).③In regression analysis,serum creatinine level in initiation of renal biopsy Was related to sclero-index,crescentic index and interstitial index(P＜0.05 for each).Conclusion The immuno deposit type or the quantity might not be associated with renal progression;The more serious glomerular sclerosis,crescent formation,interstitial lesion could be predictors of IgA nephropathy.