尿足细胞阳性IgA肾病患者不同蛋白尿水平临床病理分析

目的：探讨尿足细胞阳性的IgA肾病患者不同蛋白尿水平的临床病理特点.方法：选取原发性IgA肾病尿足细胞阳性患者41例,收集患者临床病理资料,根据尿蛋白水平分成3组：组1（≤0.5 g/24 h）（n=9）,组2（〉0.5 g/24 h,〈1.0 g/24 h）（n=14）,组3（≥1.0 g/24 h）（n=18）,比较3组临床病理特点.结果：（1）临床特点：组1患者收缩压、eGFR、UA均较组3差异有统计学意义（P〈0.05）,且这些指标在三组间随蛋白尿水平呈现递进表现.组2和组3仅在收缩压、UA方面差异有统计学意义（P〈0.05）;（2）病理特点：组1在节段性肾小球病变比例及间质炎细胞浸润方面较组3轻,差异有统计学意义（P〈0.05）;组1在节段性肾小球病变比例及节段损伤积分方面较组2轻,差异有统计学意义（P〈0.05）;组2和组3两组病理改变差异无统计学意义（P〉0.05）.结论：尿足细胞阳性的IgA肾病患者中,尿蛋白水平仍然是肾脏病轻重的一个指标,与临床病理关系密切.

Clinicopathological Features of the Primary IgA Nephropathy Patients with Positive Urinary Podocyte in Different Levels of Proteinuria

Objective： To study the clinicopathological features of the primary IgA nephropathy （IgAN） patients with positive urinary podocyte in different levels of proteinuria. Methods：41 primary IgA nephropathy patients with positive urinary podocyte were studied. These patients were classified into three categories ： groupl （ ≤ 0.5 g/24 h） （ n = 9 ）, group2 （ 〉 0.5 g/24 h, 〈 1.0 g/24 h） （n = 14） and group 3 （ ≥ 1.0 g/24 h） （n = 18 ）. Then we studied clinical and histological significance in these three groups. Results： （1） Clinical findings： There were significantly different between groupl and group3 in systolic blood pressure, estimated glomerular filtration rate （ eGFR）, blood uric acid （ UA ） （ P 〈 0.05 ）, and these factors were changed with the levels of proteinuria in three groups. Systolic blood pressure, UA in group3 were significantly greater than group2 （ P 〈 0.05 ）. （ 2 ） Histological findings ： Group3 had sig- nificantly higher incidence of segmental glomerular lesions, and interstitial inflammation than groupl （P 〈 0.05 ）. And the percentage of segmental glomerular lesions and scores of segmental glomerular lesions in group2 were significantly higher than groupl （ P 〈 0.05 ）. However there were not different between group2 and group3 in histologocal findings. Conclusion： Proteinuria is still a reliable and useful laboratory marker for the estimation of the severity of renal injury in IgAN with positive urinary podocyte.