本文關(guān)鍵詞：吸煙對原發(fā)性IgA腎病患者的臨床及病理指標(biāo)的影響　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 吸煙 IgA腎病 eGFR 腎臟病理

【摘要】：目的:探討吸煙對原發(fā)性IgA腎病患者臨床及病理指標(biāo)的影響方法:選取我院腎內(nèi)科經(jīng)首次腎穿刺活檢確診為IgA腎病的住院患者324例為研究對象。根據(jù)有無吸煙史分為吸煙組和非吸煙組。比較兩組患者的臨床指標(biāo)(性別、年齡、血壓、24小時尿蛋白定量、尿素、肌酐、估計腎小球濾過率、血紅蛋白、白蛋白、膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)與病理指標(biāo)(球性硬化、血管壁增厚、間質(zhì)炎性細(xì)胞浸潤、系膜細(xì)胞增生程度、毛細(xì)血管內(nèi)細(xì)胞增生程度、節(jié)段硬化程度與腎小管萎縮或間質(zhì)纖維化程度)的差異,探討吸煙對原發(fā)性IgA腎病患者臨床及病理指標(biāo)的影響。結(jié)果:1.共324例IgA腎病患者,吸煙者43例,占13.27%,且吸煙者均為男性患者,非吸煙組共281例,占86.73%。2.IgA腎病患者中,吸煙組的年齡、收縮壓、舒張壓、24h尿蛋白的水平明顯高于非吸煙組,e GFR的水平明顯低于非吸煙組,P0.05,差異有統(tǒng)計學(xué)意義。通過對eGFR進行pearson相關(guān)分析,發(fā)現(xiàn)eGFR與吸煙、年齡、收縮壓、舒張壓及24h尿蛋白定量呈顯著負(fù)相關(guān)(r=-0.225,P=0.000;r=-0.359,P=0.000;r=-0.429,P=0.000;r=-0.406,P=0.000;r=-0.345,P=0.000);eGFR與球性硬化、間質(zhì)炎性細(xì)胞浸潤、腎小管萎縮及間質(zhì)纖維化呈顯著負(fù)相關(guān)(ρ=-0.464,P=0.000;ρ=-0.473,P=0.000;ρ=-0.585,P=0.000;ρ=-0.526,P=0.000)。通過多重線性回歸進一步分析吸煙與eGFR的相關(guān)性,控制年齡、血壓、24小時尿蛋白、球性硬化、間質(zhì)炎細(xì)胞浸潤、腎小管萎縮及間質(zhì)纖維化可能的混雜因素后,發(fā)現(xiàn)吸煙與eGFR呈獨立負(fù)相關(guān)(P0.05)。結(jié)果提示吸煙可能是加速IgA腎病患者e GFR下降的重要危險因素,推測吸煙比不吸煙更容易引起腎功能損害。3.在腎臟病理水平,IgA腎病患者吸煙組球性硬化程度、間質(zhì)炎細(xì)胞浸潤、間質(zhì)纖維化/腎小管萎縮明顯高于非吸煙(P=0.034;P=0.004;P=0.024),差異有統(tǒng)計學(xué)意義。通過對吸煙與病理指標(biāo)進行Spearman相關(guān)分析,發(fā)現(xiàn)吸煙與球性硬化、間質(zhì)炎性細(xì)胞浸潤、腎小管萎縮及間質(zhì)纖維化呈顯著正相關(guān)(ρ=0.120,P=0.031;ρ=0.158,P=0.004;ρ=0.145,P=0.009;ρ=0.161,P=0.004)。通過Logistic回歸進一步分析吸煙對IgA腎病患者間質(zhì)炎細(xì)胞浸潤、腎間質(zhì)纖維化/腎小管萎縮的作用,調(diào)整了年齡、血壓、24小時尿蛋白可能的混雜因素,結(jié)果P值均大于0.05;因此,結(jié)果未提示吸煙與腎臟病理改變存在獨立相關(guān)性。結(jié)論:1、吸煙是影響IgA腎病患者eGFR的重要因素,提示吸煙比不吸煙更易引起腎功能損害。2、未發(fā)現(xiàn)吸煙與IgA腎病患者的腎臟病理存在獨立相關(guān)性。
[Abstract]:Objective: To investigate the effects of smoking on primary clinical and pathological characteristics of IgA nephropathy: selection of nephrology in our hospital for the first time after renal biopsy were diagnosed as IgA nephropathy patients 324 cases as the research object. According to smoking history were divided into smoking group and non smoking group. Clinical indicators of two groups of patients (gender, age, blood pressure, 24 hours urine protein, urea, creatinine, estimated glomerular filtration rate, hemoglobin, albumin, cholesterol, triglyceride, high density lipoprotein, low density lipoprotein) and pathological index (Global sclerosis, vascular wall thickening, interstitial infiltration of inflammatory cells, the proliferation of mesangial cells. Endocapillary cell hyperplasia degree, the degree of hardening and segmental renal tubular atrophy or interstitial fibrosis) differences, explore the influence of smoking on primary clinical and pathological characteristics of IgA nephropathy. Results: 1. a total of 324 cases of patients with IgA nephropathy, smoking In 43 cases, accounting for 13.27%, and smokers were male patients, non smoking group were 281 cases, accounting for 86.73%.2.IgA nephropathy patients, smoking age, systolic blood pressure, diastolic blood pressure, 24h urine protein levels were significantly higher than non smoker group, e GFR levels were significantly lower than non smoker group, P0.05, was statistically significant by Pearson correlation analysis. The difference of eGFR, eGFR and smoking, age, systolic blood pressure, diastolic blood pressure and 24h urinary protein was negatively correlated (r=-0.225, P=0.000; r=-0.359, P=0.000; r=-0.429, P=0.000; r=-0.406, P=0.000; r=-0.345, P=0.000; eGFR) and glomerulosclerosis, interstitial inflammatory cell infiltration., renal tubular atrophy and interstitial fibrosis were negatively correlated (P =-0.464, P =-0.473, P=0.000; P=0.000; P=0.000; P =-0.585, P =-0.526, P=0.000). Through multiple linear regression analysis further smoking associated with the eGFR, controlling for age, blood pressure, urinary protein in 24 hours, the ball Sclerosis, interstitial infiltration of inflammatory cells and fibrosis may be confounding factors of renal tubular atrophy and later found that smoking and eGFR were negatively correlated (P0.05). The results indicated that smoking may be an important risk in patients with IgA nephropathy e GFR accelerated decline factors, that smoking than non-smokers more easily cause renal damage in.3. the level of IgA in patients with renal pathology, smoking nephropathy group glomerulosclerosis, interstitial inflammatory cell infiltration, interstitial fibrosis and tubular atrophy was significantly higher than that of non smoking (P=0.034; P=0.004; P=0.024), the difference was statistically significant. Spearman correlation analysis was conducted through physical indicators of smoking and disease, smoking and glomerulosclerosis, interstitial inflammation infiltration of inflammatory cells, renal tubular atrophy and interstitial fibrosis were positively correlated (P =0.120, P =0.158, P=0.031; P=0.004; P=0.009; P =0.145, P =0.161, P=0.004). Through Logistic regression analysis of smoking on IgA nephropathy patients Those interstitial infiltration of inflammatory cells, the role of renal interstitial fibrosis / renal tubular atrophy, adjusting for age, blood pressure, 24 hour urine protein potentially confounding factors, the P values are greater than 0.05; therefore, the results did not reveal any independent association between smoking and renal pathological changes. Conclusion: 1. Smoking is an important factor affecting eGFR in patients with IgA nephropathy, suggesting that smoking causes renal damage.2 more often than not smoking, no smoking and renal pathology in IgA nephropathy patients were independently associated.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.31

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