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目的分析不同程度尿检异常的IgA肾病患者临床病理特点。方法对我院行肾活检病理诊断为IgA肾病的258例患者的临床及病理资料进行回顾性分析,按Lee氏分级标准将肾脏的病理改变分级,采用Katafuch i的半定量标准做肾小球、肾小管间质、肾血管病变评分。依据尿检程度分为显微镜血尿伴或不伴蛋白尿组(A组)、蛋白尿组(B组),分析两组间患者的临床及肾脏病理学指标并进行比较。结果 IgA肾病患者临床表现多样,以慢性肾炎(53.10%)为最常见,蛋白尿、血尿发生率分别达84.88%、86.43%;病理分级两组主要以Ⅲ、Ⅳ级为主(89.15);伴有肾小管间质损害者234例(90.70%)。B组24 h尿蛋白定量、肾小球总积分、系膜增殖、节段损害、球性硬化、肾小管间质积分明显高于A组(P<0.05)。结论以蛋白尿为主要临床表现的IgA肾病患者蛋白含量较高,其临床表现及病理分级相对较重,预后较差。提示肾活检对判断肾脏病变意义重大,且对IgA肾病的临床与病理进行相关分析,能全面评估预后并指导制定有效的治疗方案。
Objective To analyze the clinicopathological features of IgA nephropathy patients with abnormal urinalysis. Methods The clinical and pathological data of 258 patients with IgA nephropathy diagnosed by renal biopsy in our hospital were retrospectively analyzed. According to Lee’s grading criteria, the pathological changes of the kidneys were graded, and the semi-quantitative standard of Katafuch i was used to make the glomeruli, Tubulointerstitial and renal vascular disease score. According to the degree of urinalysis were divided into microscopic hematuria with or without albuminuria (group A), albuminuria (group B), analysis of clinical and renal pathology between the two groups of patients and compared. Results The clinical manifestations of patients with IgA nephropathy varied. Chronic glomerulonephritis (53.10%) was the most common type. The incidence of proteinuria and hematuria was 84.88% and 86.43% respectively. The pathological grade was dominated by grade Ⅲ and Ⅳ (89.15). There were 234 cases of tubulointerstitial damage (90.70%). Group B 24 h urinary protein, glomerular total score, mesangial proliferation, segmental lesions, sclerosis and tubulointerstitial score were significantly higher than those in group A (P <0.05). Conclusion Proteinuria is the main clinical manifestation of IgA nephropathy in patients with high protein content, its clinical manifestations and pathological grading is relatively heavy, the prognosis is poor. Prompt renal biopsy to determine the significance of renal disease, and IgA nephropathy clinical and pathological correlation analysis, can fully assess the prognosis and guide the development of effective treatment options.