正常血压IgA肾病患者动脉病变的意义

目的:传统观点认为动脉硬化与高血压有关。然而,部分IgA肾病患者,尽管血压正常,但仍有动脉硬化的改变。本研究的目的就是比较血压正常、伴有和不伴有动脉病变的IgA肾病患者的临床病理特点,探讨正常血压IgA肾病患者肾内动脉病变的影响因素及意义。方法:所有患者均经肾活检诊断为原发性IgA肾病,无高血压病史,肾活检前血压<140/90mmHg。动脉病变的定义为活检肾组织光镜下见动脉壁增厚和(或)动脉玻璃样变。符合标准的105例患者,根据动脉病变的有无分为两组,有动脉病变组52例、无动脉病变组53例,分别比较两组的临床病理特点。肾脏动脉病变的半定量分级标准:0:无损害;1:<25%;2:≥25%,<50%;3:≥50%。统计学方法:分别比较两组的临床病理特点,将差异有统计学意义的单因素指标作为多因素分析的入选指标,采用逐步回归方法分析动脉病变的影响因素,以P<0.05作为差异有统计学意义。结果:与无动脉病变组比较,动脉病变组肾活检时的年龄、血肌酐、血尿酸、尿蛋白定量、尿NAG酶、肾小球硬化、肾小管萎缩以及肾间质纤维化的程度显著增高,尿渗透压显著下降。多因素分析的结果表明,肾活检时的血肌酐、尿渗透压、肾小管萎缩及肾间质纤维化是正常血压IgA肾病动脉病变的独立影响因素。动脉病变的程度与血肌酐、肾小管萎缩及肾间质纤维化呈正相关;与尿渗透压呈负相关。结论:血压正常IgA肾病患者的肾内动脉病变,主要与年龄、血肌酐、血尿酸增高等因素有关,常伴有肾小管间质损害。

Significance of Arterial Lesions in IgA Nephropathy Patients with Normal Blood Pressure

Objective:Arteriosclerosis is traditionally thought to be related with hypertension.However,intrarenal arteriosclerosis was observed in some IgA nephropathy(IgAN) patients with normal blood pressure.This study was designed to compare the clinical and pathological characteristics of those normotensive IgAN patients with or without arterial lesions,and to investigate the factors that affecting intrarenal arterial lesions in IgAN patients with normal blood pressure.Methods:All normotensive patients(BP<140/90 mmHg before renal biopsy) were diagnosed as primary IgAN by renal biopsy.The intrarenal arterial lesions were defined as thickening and/or hyalinosis of the small arteries via light microscope.105 patients were enrolled and divided into two groups:52 patients with intrarenal arterial lesions in group 1,and 53 patients without intrarenal arterial lesions in group 2.The semiquantitative scoring criteria of the pathological changes in intrarenal arteries was:0:no change;1:<25%;2:≥25%,<50%;3:≥50%。Statistics:After comparing the clinical and pathological characteristics in two groups,those single factors with statistic significance were rendered into multifactor analysis,and the affecting factors were analyzed by stepwise regression analysis.Results:When compared with group 2,there was a significantly increased age,serum creatinine,serum uric acid,daily urine protein excretion,urine NAG,and more severe glomerulosclerosis,tubular atrophy and interstitial fibrosis,and a markedly decreased urine osmotic pressure at the time of renal biopsy in group 1.Multifactor analysis showed that serum creatinine,urine osmotic pressure,tubular atrophy and interstitial fibrosis are independently affecting factors for intrarenal arterial lesions in IgAN patients with normal blood pressure.The severity of intrarenal arterial lesions is positively correlated with serum creatinine,tubular atrophy and interstitial fibrosis,and negatively correlated with urine osmotic pressure.Conclusion:The results of this study showed that intrarenal arterial lesions in IgAN patients with normal blood pressure is mainly associated with age,elevated serum creatinine and uric acid,and is usually accompanied with tubulointerstitial lesions.