伴有慢性肾衰竭的马兜铃酸肾病与IgA肾病的配对研究

目的:了解伴有慢性肾衰竭的马兜铃酸肾病患者与IgA肾病患者的临床病理差异.方法:分析11例马兜铃酸肾病患者的临床病理资料,并与经肾活检确诊的IgA肾病患者进行配对比较.结果:两组患者的年龄、性别、血肌酐水平无明显差异(P>0.05),马兜铃酸肾病患者镜下血尿发生率低于IgA肾病患者(P<0.05).在血肌酐水平无明显差异时,马兜铃酸肾病患者血红蛋白浓度明显低于IgA肾病患者(P<0.01),尿蛋白定量和肾脏的长径少于IgA肾病患者(P<0.05).间质纤维化程度重于IgA肾病患者(P<0.05),而间质炎细胞浸润少(P<0.05).结论:伴有慢性肾衰竭的马兜铃酸肾病患者临床发展隐匿,与IgA肾病比较,肾小管间质损伤是造成肾功能损害的主要原因,因此要重视对马兜铃酸肾病的早期防治.

Matched Case-Controlled Study of Aristolochic Acid Nephropathy and IgA Nephropathy in Patients with Chronic Renal Failure

Objective:To study the clinicopathological difference between the aristolochic acid nephropathy and IgA nephropathy with chronic renal failure.Methods:11 patients of aristolochic acid nephropathy with chronic renal failure in our division were reviewed and their clinical,laboratory and pathologic manifestations were analyzed as compared to IgA nephropathy patients by one-to-one matched design (paired).Results:Age, sex, and serum creatinine lever were not statistically different between the two groups. The group of aristolochic acid nephropathy showed lower incidence of hematuria than IgA nephropathy group (P<0.05).The lower lever of serum hemoglobin,proteinuria and kidney size were observed in the group of aristolochic acid nephropathy than IgA nephropathy group (P<0.05) while serum creatinine lever were not statistically different. Heavier interstitial fibrosis and fewer inflammatory cells in the interstitium were also shown in the group of aristolochic acid nephropathy.Conclusion:Aristolochic acid nephropathy with chronic renal failure progresses with no obvious clinic manifestations as compared to IgA nephropathy. Serious tubular atrophy and interstitial fibrosis are main pathologic characteristics. It is important to diagnose and treat aristolochic acid nephropathy early.