以血尿和(或)蛋白尿表现的IgA肾病临床与病理分析

目的分析以血尿和(或)蛋白尿为表现IgA肾病的临床与病理改变，为临床治疗估计预后提供依据。方法经临床和肾活检确诊的34例IgA肾病分为两组，单纯组及复合组(根据IgA在肾小球沉积的部位不同)，分别测定血尿素氮、肌酐、尿β2-微球蛋白及尿视黄醇结合球蛋白。结果复合组免疫球蛋白在肾小球沉积的类型与单纯组比较差异显著(P＜0．05)；病理分级单纯组以I、Ⅱ级为主，复合组以Ⅲ级为主；复合组尿β2-微球蛋白、尿视黄醇结合球蛋白增高与单纯组比有显著差异(P＜0．05)。结论血尿和(或)蛋白尿为表现的IgA肾病在系膜合并毛细血管沉积者中肾小管功能损害程度较单纯系膜区沉积者严重，其中“持续性镜下血尿伴蛋白尿”者在复合组中所占比例为高，病理改变较重，预后较差。

The Clinical and Pathological Analysis of IgA Nephropathy with Hematuria and/or Proteinuria

Objective To analyse the clinical and pathological changes of IgA nephropathy with hematuria and/or proteinuria and to provide guideline of estimating the clinical prognosis. Methods 34 cases IgA nephropathy diagnosed clinically and confirmed by biopsy were divided into two groups according to the different localities of IgA deposit in glomerulus. Serum Bun,Cr,urinary B2-MG and urinary RBP (Retinal Binding Protein) were determined in all cases of the two groups. Results There was a significant difference between two groups in depositing immunoglobulin in glomerulus (P＜0.05). There was a significant increase in urinary B2-MG;and urinary RBP in complex group (P＜0.05). Conclusion The damage of renal tubule and pathological change were heavy in the complex group,especially in continual microscopic hematuria and proteinuria. The outcome of these patients is usually bad.