本文選題：IgA腎病　切入點(diǎn)：腎內(nèi)小動(dòng)脈病變　出處：《首都醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：建立定量的IgA腎病小動(dòng)脈病變?cè)u(píng)估標(biāo)準(zhǔn)，對(duì)高血壓和正常血壓的IgA腎病患者的小動(dòng)脈病變進(jìn)行臨床及病理分析。 方法：①連續(xù)性納入我科2010年3月至2013年10月期間腎活檢病理示腎臟病變輕微的非IgA腎病患者50例作為正常對(duì)照人群，以等圓面積換算法（間接法）測(cè)定小動(dòng)脈內(nèi)、外直徑，并計(jì)算每位患者全部測(cè)定小動(dòng)脈的內(nèi)外徑比平均值，根據(jù)該值建立IgA腎病小動(dòng)脈病變?cè)u(píng)估標(biāo)準(zhǔn)。②連續(xù)納入我科同一時(shí)期行腎活檢，病理診斷為IgA腎病的患者305例，根據(jù)①制定的標(biāo)準(zhǔn)，將其分為正常組、輕度病變組、重度病變組，對(duì)其臨床指標(biāo)（年齡、性別、收縮壓、舒張壓、SCr、UPr、UOP）和病理指標(biāo)（IGS百分比）通過(guò)組間比較、單因素及多因素logistic回歸進(jìn)行分析。③對(duì)血壓正常的IgA腎病患者147例，采用與②相同的方法進(jìn)行小動(dòng)脈病變的臨床及病理分析。 結(jié)果：①正常對(duì)照人群的全部患者小動(dòng)脈內(nèi)直徑/外直徑平均值為0.52±0.05。IgA腎病小動(dòng)脈病變?cè)u(píng)價(jià)標(biāo)準(zhǔn)為：內(nèi)外徑比值＞0.48為正常范圍，0.45～0.48為輕度病變，≤0.45為重度病變。②IgA腎病患者小動(dòng)脈病變發(fā)生率為36.4%，重度病變患者占全部的13.3%。與正常組相比，輕、重度病變組的收縮壓、舒張壓、SCr、IGS百分比均顯著升高（P＜0.05），而UOP顯著降低（P＜0.05）。重度病變組的舒張壓、SCr及IGS百分比顯著高于輕度病變組，UOP低于輕度病變組，雖無(wú)顯著性差異，但有降低趨勢(shì)。多因素logistic回歸分析示：收縮壓、SCr、UOP、IGS百分比與IgA腎病腎內(nèi)小動(dòng)脈病變程度獨(dú)立相關(guān)。③血壓正常的IgA腎病患者小動(dòng)脈病變發(fā)生率為26.5%，重度病變患者占7.5%，與管壁正常組比較，，管壁輕、重度病變組的SCr及IGS百分比均顯著升高（P＜0.05），UOP均降低，其中重度病變組差異有顯著性（P＜0.05）。而輕、重度病變組相互比較，后者的SCr較前者顯著增高，UOP顯著降低（P＜0.05）。UOP、IGS百分比與血壓正常的IgA腎病腎內(nèi)小動(dòng)脈病變程度獨(dú)立相關(guān)。 結(jié)論：本研究采用間接法測(cè)定腎內(nèi)小動(dòng)脈病變程度，通過(guò)對(duì)小動(dòng)脈正�；颊叩难芯�，建立起小動(dòng)脈病變程度評(píng)價(jià)標(biāo)準(zhǔn)。將該標(biāo)準(zhǔn)應(yīng)用于IgA腎病患者，發(fā)現(xiàn)腎內(nèi)小動(dòng)脈病變可以出現(xiàn)在血壓正常及高血壓的IgA腎病患者中，并且隨著小動(dòng)脈病變的加重患者常常出現(xiàn)更為嚴(yán)重的腎小球及腎小管損傷。
[Abstract]:Objective: to establish a quantitative evaluation standard for arteriolar lesions of IgA nephropathy and to analyze the clinical and pathological features of arteriolar lesions in patients with hypertension and normotensive IgA nephropathy. Methods from March 2010 to October 2013, 50 cases of non IgA nephropathy with mild renal lesions were included as normal controls. The internal and external diameters of arterioles were measured by equal circle area conversion method (indirect method). The mean ratio of internal and external diameter of arterioles was calculated. According to this value, the evaluation standard of arteriolar lesions of IgA nephropathy was established, which was included in renal biopsy in the same period of time in our department. 305 patients with IgA nephropathy were diagnosed by pathology. According to the established criteria, they were divided into normal group, mild lesion group and severe lesion group. The clinical indexes (age, sex, systolic blood pressure, diastolic blood pressure (SCR) UPrU UOPP) and pathological index (IGS percentage) were compared among groups. Univariate and multivariate logistic regression was used to analyze the clinical and pathological changes of arterioles in 147 IgA nephropathy patients with normal blood pressure. Results the mean internal and external diameter of arterioles was 0.52 鹵0.05.IgA nephropathy in the normal control group. The evaluation criteria were as follows: the ratio of internal and external diameter > 0.48 was normal, 0.45 and 0.48 were mild lesions. The incidence of arteriopathy in patients with IgA nephropathy 鈮

本文編號(hào)：1588315