發(fā)布時間：2018-11-13 12:20

【摘要】：目的:探討血清膽紅素水平與IgA腎病臨床及病理的關系,為指導IgA腎病患者的治療提供理論依據(jù)。方法:回顧性橫斷面研究。納入2008年8月至2015年12月在寧夏醫(yī)科大學總醫(yī)院腎臟內(nèi)科明確診斷為IgA腎病的患者。收集患者的一般資料、實驗室檢查及病理資料。分析IgA腎病患者血清膽紅素水平與實驗室指標及病理結果的關系。結果:本研究共納入IgA腎病患者612例,其中男性患者326例(53.3%),女性患者286例(46.7%)。(1)血清膽紅素水平按四分位數(shù)間距分組,隨著血清膽紅素水平逐漸升高,血清總蛋白、白蛋白、血紅蛋白水平逐漸升高,血糖、24小時尿蛋白定量逐漸減低,腎小球系膜細胞增生、腎小管萎縮/間質(zhì)纖維化的程度逐漸減輕(P0.05);(2)將24小時尿蛋白定量以1g為界分組,24小時尿蛋白定量≥1g較1g組患者的舒張壓、收縮壓、平均動脈壓、血清肌酐、甘油三酯水平高,總蛋白、白蛋白、膽紅素、eGFR低,病理損傷程度重(P0.05);(3)將eGFR以45 ml/min/1.73m2為界分組,eGFR≥45ml/min/1.73m2組較45 ml/min/1.73m2組患者年齡小,舒張壓、收縮壓、平均動脈壓、血清肌酐、尿酸、24小時尿蛋白定量、血紅蛋白水平低,高血壓的發(fā)生率低,膽紅素、總蛋白、白蛋白水平高,病理損傷程度輕(P0.05);(4)按臨床表現(xiàn)是否為腎病綜合征分組,腎病綜合征組的患者舒張壓、收縮壓、平均動脈壓、血清肌酐、總膽固醇較非腎病綜合征組高,膽紅素、血紅蛋白、eGFR水平低,系膜細胞增生、腎小管萎縮/間質(zhì)纖維化程度重(P0.05);(5)系膜細胞增生程度分組,M1組的收縮壓、平均動脈壓、血清肌酐、血糖、尿蛋白定量、血尿發(fā)生率較M0組高,總蛋白、膽紅素、血紅蛋白、eGFR較M0組低(P0.05);(6)以腎小管萎縮/間質(zhì)纖維化程度分組,隨著病理損傷程度加重,舒張壓、收縮壓、平均動脈壓、血清肌酐、尿酸、尿蛋白定量、高血壓的發(fā)生率逐漸增加,總蛋白、白蛋白、血紅蛋白、eGFR逐漸降低,T0組的膽紅素水平較T1和T2組高(P0.05);(7)相關危險因素Logistic回歸分析顯示:IgA腎病患者舒張壓、收縮壓、血清肌酐、血糖、尿蛋白定量升高為系膜細胞增生的非保護性因素,膽紅素、血紅蛋白、eGFR升高為系膜細胞增生的保護性因素(P0.05);舒張壓、收縮壓、平均動脈壓、血清肌酐、尿酸、尿蛋白定量升高為腎小管萎縮/間質(zhì)纖維化的非保護性因素,總蛋白、白蛋白、膽紅素、血紅蛋白、eGFR升高為腎小管萎縮/間質(zhì)纖維化的保護性因素。結論:血清膽紅素水平可能在IgA腎病的發(fā)生發(fā)展中起一定作用,高血清膽紅素水平的IgA腎病患者其臨床病理可能更輕。
[Abstract]:Objective: to investigate the relationship between serum bilirubin level and clinical and pathological changes of IgA nephropathy, and to provide theoretical basis for guiding the treatment of IgA nephropathy. Methods: retrospective cross-sectional study. The patients with IgA nephropathy were included in the Department of Renal Medicine, General Hospital of Ningxia Medical University from August 2008 to December 2015. Collect general data, laboratory examination and pathological data of patients. To analyze the relationship between serum bilirubin level and laboratory indexes and pathological results in patients with IgA nephropathy. Results: a total of 612 patients with IgA nephropathy were included in this study, including 326 male patients (53.3%) and 286 female patients (46.7%). (1) whose serum bilirubin levels were grouped according to quartile spacing. With the increase of serum bilirubin level, serum total protein, albumin, hemoglobin level gradually increased, blood sugar, 24 hours urine protein quantity decreased gradually, glomerular Mesangial cells proliferated. The degree of tubular atrophy / interstitial fibrosis gradually decreased (P0.05). (2) the 24 hour urinary protein quantification was divided into 1 g and 1 g respectively. The diastolic blood pressure, systolic blood pressure, mean arterial pressure, serum creatinine, triglyceride level, total protein, albumin, bilirubin and eGFR were lower in 24 hours urinary protein 鈮，

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