發(fā)布時間：2018-06-17 10:43

  本文選題：IgA腎病 + 牛津分型��； 參考：《中國醫(yī)科大學學報》2017年01期

【摘要】：目的研究Ig A腎病牛津分型的4種主要病變:系膜細胞增生(M0/1)、內(nèi)皮細胞增生(E0/1)、節(jié)段性硬化或粘連(S0/1)、腎小管萎縮或腎間質(zhì)纖維化(T0/1/2)與臨床指標之間的相關(guān)性及危險因素。方法收集2006年2月17日至2011年10月11日在中國醫(yī)科大學附屬第一醫(yī)院腎內(nèi)科經(jīng)腎活檢確診的514例18歲以上Ig A腎病患者的臨床及病理資料。除外過敏性紫癜、強直性脊柱炎、銀屑病等繼發(fā)性Ig A腎病。采用χ~2檢驗、Spearman秩相關(guān)、二分類及多因素logistic回歸分析進行統(tǒng)計學分析。結(jié)果514例Ig A腎病患者中,男女比例1.06∶1,平均年齡(35.70±11.99)歲,平均病程(18.31±30.42)個月。單純血尿組牛津分型以M0E0S0T0為主。慢性腎臟病腎功能分期、24 h尿蛋白定量、尿微量白蛋白、尿轉(zhuǎn)鐵蛋白、尿Ig G與M病變呈正相關(guān);血清白蛋白、C3、血小板與M病變呈負相關(guān)。24 h尿蛋白定量和血小板升高是影響系膜細胞增生程度的獨立危險因素。尿蛋白≥3.5 g的患者M1的比例(67.5%)顯著高于非腎病范圍蛋白尿的患者。年齡、收縮壓、尿紅細胞計數(shù)、24 h尿蛋白定量、尿微量白蛋白、尿轉(zhuǎn)鐵蛋白、尿Ig G與E病變呈正相關(guān);病程、血清白蛋白與E病變呈負相關(guān)。年齡、病程長是E病變加重的獨立危險因素。60歲以上患者E1的比例(73.3%)顯著高于60歲以下患者。CKD分期、收縮壓、24 h尿蛋白定量與S病變呈正相關(guān)。年齡、CKD腎功能分期、收縮壓、舒張壓、C4、甘油三酯、低密度脂蛋白、C反應蛋白、血清纖維蛋白原、血尿酸、血胱抑素C、24 h尿蛋白定量、尿β2微球蛋白、尿微量白蛋白、尿轉(zhuǎn)鐵蛋白、尿Ig G與T病變程度呈正相關(guān),血紅蛋白、血清白蛋白、血Ig G與T病變呈負相關(guān)。前驅(qū)感染史、舒張壓≥90 mm Hg、低白蛋白血癥、高低密度脂蛋白血癥、貧血、高C反應蛋白血癥是T病變加重的影響因素。結(jié)論24 h尿蛋白定量和血小板升高,高齡,病程長,存在低白蛋白血癥、貧血、高脂血癥、前驅(qū)感染、舒張壓升高、高C反應蛋白血癥是Ig A腎病患者牛津分型病變嚴重的危險因素,對存在上述因素的患者應及時行腎活檢,明確病理分級,給予個體化治療,以改善預后。
[Abstract]:Objective to study the correlation and risk factors between the four major pathological changes of IgA nephropathy: Mesangial cell proliferation (M0 / 1), endothelial cell proliferation (E0 / 1 / 1), segmental sclerosis or adhesion (S0 / 1), tubular atrophy or renal interstitial fibrosis (T0 / 1 / 2). Methods from February 17, 2006 to October 11, 2011, the clinical and pathological data of 514 patients with IgA nephropathy over 18 years old diagnosed by renal biopsy in the first affiliated Hospital of China Medical University were collected. Except allergic purpura, ankylosing spondylitis, psoriasis and other secondary IgA nephropathy. 蠂 ~ 2 test was used to analyze Spearman's rank correlation, two-classification and multivariate logistic regression analysis. Results in 514 patients with IgA nephropathy, the ratio of male to female was 1.06: 1, with an average age of 35.70 鹵11.99 years and an average course of 18.31 鹵30.42 months. In simple hematuria group, the main Oxford typing was M0E0S0T0. There was a positive correlation between urinary microalbuminuria, urinary transferrin, urinary IgG and M lesion. Serum albumin C _ 3, platelet and M lesion were negatively correlated. 24 h urinary protein quantification and platelet elevation were independent risk factors for the degree of Mesangial cell proliferation. The proportion of M1 in patients with urinary protein 鈮，

本文編號：2030758