中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (1): 1-6.doi: 10.12007/j.issn.0258-4646.2017.01.001

• 论著 •    下一篇

IgA 肾病牛津分型与临床指标的相关性及危险因素分析

李卅立 1,2,范秋灵 1,赵洁 1,刘楠 1,王曦 1,姜奕 1,王力宁 1   

  1. 1中国医科大学附属第一医院肾内科,沈阳 110001;2沈阳医学院附属第二医院肾内科,沈阳 110002
  • 收稿日期:2016-04-20 出版日期:2017-01-28 发布日期:2017-01-10
  • 通讯作者: 范秋灵 E-mail:cmufql@163.com
  • 作者简介:李卅立(1985 -),女,医师,硕士研究生 .
  • 基金资助:
    国家自然科学基金(81270808);辽宁省高等学校重大科技平台免疫皮肤病学重点实验室自主 创新课题(201303);沈阳市科技计划(F16-205-1-40)

Risk Factors and Correlation Analysis between the Oxford Classification and Clinical Indicators of IgA Nephropathy

LI Sali1,2,FAN Qiuling1,ZHAO Jie1,LIU Nan1,WANG Xi1,JIANG Yi1,WANG Lining1   

  1. 1Department of Nephrology,The First Hospital,China Medical University,Shenyang 110001,China;2 Department of Nephrology,The Second Affiliated Hospital of Shenyang Medical College,Shenyang 110002,China
  • Received:2016-04-20 Online:2017-01-28 Published:2017-01-10

摘要: 目的 研究 IgA 肾病牛津分型的 4 种主要病变:系膜细胞增生(M0/1)、内皮细胞增生(E0/1)、节段性硬化或粘连(S0/1)、 肾小管萎缩或肾间质纤维化(T0/1/2)与临床指标之间的相关性及危险因素。方法 收集 2006 年 2 月 17 日至 2011 年 10 月 11 日 在中国医科大学附属第一医院肾内科经肾活检确诊的 514 例 18 岁以上 IgA 肾病患者的临床及病理资料。除外过敏性紫癜、强 直性脊柱炎、银屑病等继发性 IgA 肾病。采用 χ2 检验、Spearman 秩相关、二分类及多因素 logistic 回归分析进行统计学分析。结果 514 例 IgA 肾病患者中,男女比例 1.06∶1,平均年龄(35.70±11.99)岁,平均病程(18.31±30.42)个月。单纯血尿组牛津分型以 M0E0S0T0 为主。慢性肾脏病肾功能分期、24 h 尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿 IgG 与 M 病变呈正相关;血清白蛋 白、C3、血小板与 M 病变呈负相关。24 h 尿蛋白定量和血小板升高是影响系膜细胞增生程度的独立危险因素。尿蛋白≥3.5 g 的 患者 M1 的比例(67.5%)显著高于非肾病范围蛋白尿的患者。年龄、收缩压、尿红细胞计数、24 h 尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿 IgG 与 E 病变呈正相关;病程、血清白蛋白与 E 病变呈负相关。年龄、病程长是 E 病变加重的独立危险因素。60 岁 以上患者 E1 的比例(73.3%)显著高于 60 岁以下患者。CKD 分期、收缩压、24 h 尿蛋白定量与 S 病变呈正相关。年龄、CKD 肾功 能分期、收缩压、舒张压、C4、甘油三酯、低密度脂蛋白、C 反应蛋白、血清纤维蛋白原、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、尿转铁蛋白、尿 IgG 与 T 病变程度呈正相关,血红蛋白、血清白蛋白、血 IgG 与 T 病变呈负相关。前驱感染史、舒张压≥90 mmHg、低白蛋白血症、高低密度脂蛋白血症、贫血、高 C 反应蛋白血症是 T 病变加重的影响因素。结论 24 h 尿蛋白定量和血小板升高,高龄,病程长,存在低白蛋白血症、贫血、高脂血症、前驱感染、舒张压升高、高 C 反应蛋白血症是 IgA 肾病患者牛津分型病变严重的危险因素,对存在上述因素的患者应及时行肾活检,明确病理分级,给予个体化治疗,以改善预后。

关键词: IgA 肾病, 牛津分型, 临床指标, 危险因素, 相关分析

Abstract: Objective To analyze the risk factors and correlation between clinical indicators and the four main pathological lesions of IgA nephropathy in the Oxford classification:mesangial hypercellularity(M0/1),endocapillary proliferation(E0/1),segmental sclerosis or adhesion(S0/1), and tubular atrophy/interstitial fibrosis(T0/1/2). Methods Clinical and pathological data were collected from 514 patients with biopsy-proven IgA nephropathy admitted in our hospital from February 17,2006 to October 11,2011. These patients were all above 18 years old. Cases with secondary causes of mesangial IgA deposition were excluded,such as Henoch-chonlein purpura,ankylosing spondylitis and psoriasis et al. The independent risk factors affecting the pathological classification were analyzed by Spearman rank correlation analysis and two-category and multi-classification logistic regression using SPSS 17.0 statistical software. Results In 514 IgAN patients,the ratio of males to females was 1.06∶1. The average age was 35.70±11.99 years,and the average disease duration was 18.31±30.42 months. M0E0S0T0 was the major pathologic classification of isolated hematuria. Chronic kidney disease(CKD)stage,24 hours proteinuria,albuminuria,urine transferrin and IgG levels were positively correlated with M lesion;serum albumin,C3 and PLT showed a negative correlation with M lesion. Twenty four hours proteinuria and blood platelet count were the independent risk factors for M lesion. As shown by stratified analysis,the proportion of M1 in cases with 24 hours proteinuria≥3.5 g/ d is much higher than that in cases with non-nephrotic range proteinuria. Age,systolic blood pressure,uRBC,24 hours proteinuria,albuminuria urine transferrin and IgG levels were positively correlated with E lesion,Duration,serum albumin showed a negative correlation with E lesion. Age and duration of nephritis were independent risk factors for E lesion. 73.3% of patients that above 60 years old showed endothelial proliferation.CKD stage,24 hours proteinuria were positively correlated with S lesion. Age,CKD stage,systolic blood pressure,diastolic blood pressure,C4,TC,LDL-C,CRP,Fib,UA,Cys-C and 24 hours proteinuria,urine β2-microglobulin,albumin,transferrin and IgG levels were positively associated with T lesion;hemoglobin,serum albumin,serum IgG showed a negative correlation with T lesion. Infection history,high CRP levels,DBP more than 90 mmHg,hypoalbuminemia,high low density lipoproteinemia,and anemia were independent risk factors for T lesion. Conclusion Twenty four hours proteinuria,blood platelet count,age,duration of nephritis,hypoalbuminemia,anemia,hyperlipidemia,DBP≥90 mmHg and high CRP levels were risk factors for the Oxford classification of IgA nephropathy. Renal biopsy should be carried out in time to make clear the pathological classification and individual treatment,so as to improve the prognosis.

Key words: IgA nephropathy, Oxford classification, clinical indicators, risk factor, correlation

中图分类号: 

  • R692.6
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