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学科主题: 肾脏病学
题名:
IgA肾病尿沉渣谱与肾脏病理改变的相关关系
其他题名: Association of urinary sediments with renal pathological patterns in IgA nephropathy
作者: 李惊子1; 王素霞1; 秦小琪1; 许远1; 曹慧霞1; 王亚芳1; 鄂洁1; 郑欣1
关键词: IgA肾病 ; 尿分析 ; 活组织检查,肾 ; 位相差显微镜 ; IgA nephropathy ; Urinary sediment spectrum ; Renal biopsy,Phase-contrast microscopy
刊名: 中华肾脏病杂志
发表日期: 2015
DOI: 10.3760/cma.j.issn.1001-7097.2015.02.003
卷: 31, 期:2, 页:91-96
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 探讨IgA肾病患者尿沉渣谱与肾脏病理损伤类型的相关性.方法 病例来自北京大学第一医院肾内科住院的IgA肾病患者516例,采集患者肾活检日晨尿标本516份.相位差显微镜下检查尿沉渣谱改变.按照尿沉渣谱分为3型:血尿型(变形红细胞);活动型(变形红细胞伴红细胞管型和/或偶见有核细胞管型);进展型(多细胞、多管型,尤其蜡样管型).肾活检组织行光镜、免疫荧光和电镜检查,确定病理改变和损伤类型.对肾活检日晨血尿阳性患者行尿沉渣谱与病理改变类型的相关性分析.结果 (1)病理改变类型以局灶增生型最多见(75.2%);其次为系膜增生型(7.0%);增生硬化型(6.8%);毛细血管内增生型(2.9%)及新月体型(2.3%).(2)肉眼血尿检出率15.7%,肾活检日镜下血尿检出率74.8%,以单纯蛋白尿表现者6%.(3)386例患者尿沉渣谱与肾脏病理改变类型的相关性分析结果显示:血尿型占54%,主要见于无明显活动病变的局灶增生性IgA肾病或伴肾小球硬化和缺血性肾损伤,以及增生硬化性IgA肾病和中晚期新月体病例,符合率为79.4%.活动型占35%,主要见于肾小球或肾小管间质有活动性病变者.进展型占11%,主要见于新月体性和毛细血管内增生性IgA肾病,或伴急性小管间质肾病患者.IgA肾病患者的肾脏病理有活动性病变的尿沉渣谱以活动和进展型为主,符合率为79.2%.肾脏病理的活动性与非活动性的尿沉渣谱类型分布的差异有统计学意义(P<0.01).(4)多因素分析结果显示尿沉渣谱改变是肾脏是否有活动性损伤的危险因素(P<0.01).结论 IgA肾病的尿沉渣谱类型可反映肾病理损伤的活动性.尿沉渣谱检查方法简便、易行,可作为临床随诊的无创监测指标. Objective To investigate the relationship between urinary sediments and renal pathological patterns in IgA nephropathy.Methods A total of 516 specimens of fresh fasting morning urine were collected.Urinary specimens were processed routinely and examined with phasecontrast microscopy.Urinary sediments were classified into three types according to the components:type Ⅰ:hematuria containing dysmorphic red blood cells(RBCs); type Ⅱ:active urinary sediments containing hematuria and casts of RBCs,and/or a few casts containing white blood cells or epithelial cells; type Ⅲ:advanced urinary sediments containing hematuria,and various casts consisted of red and white blood cells,renal tubular epithelial cells,and waxy casts.Pathological patterns of IgA nephropathy were classified according to the descriptive diagnosis of pathological lesions.Statistical analysis were performed using kappa test,X2 test,and significance was accepted at P < 0.05.Results The pathological patterns of 516 cases of IgA nephropathy included focal proliferative pattern in 75.2%,mesangial proliferative pattern in 7%,proliferative and sclerosing pattern in 6.8%,endocapillary proliferative pattern in 2.9%,crescentic pattern in 2.3% respectively.Hematuria was present in 74.8% (386/516 cases) of patients before renal biopsy,15.7% of them had gross hematuria.Urinary sediments of 386 cases consisted of 54% of type Ⅰ,35% of type Ⅱ,and 11% of type Ⅲ respectively.Type Ⅰ urinary sediment was present in focal proliferative pattern without active lesions,its concordance was 79.4%; while type Ⅱ were mainly seen in cases with glomerular and/or tubulointerstitial active lesions; type Ⅲ were seen in crescentic or endocapillary proliferative patterns and/or cases with active tubulointerstitial lesions.The concordance of type Ⅱ and type Ⅲ urinary sediments with active glomerular and tubulointerstitial lesions in IgA nephropathy was 79.2%.There was a significant difference in urinary sediment types between active and non-active pathological lesions (P < 0.01).Multivariate analysis indicated urinary sediment types independently predicted the active and non-active lesions in IgA nephropathy (P < 0.01,OR=7.268).Conclusions Urinary sediment analysis is an easy and valuable method to predict the active and non-active lesions of renal pathology in IgA nephropathy,can be used as a non-invasive indicator of clinical course.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/45866
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.100034,北京大学第一医院肾内科北京大学肾脏疾病研究所卫生部肾脏疾病重点实验室慢性肾脏病防治教育部重点实验室
2.北京大学第一医院电镜室超微病理中心
3.北京大学第一医院医学统计室
4.河南省人民医院肾内科

Recommended Citation:
李惊子,王素霞,秦小琪,等. IgA肾病尿沉渣谱与肾脏病理改变的相关关系[J]. 中华肾脏病杂志,2015,31(2):91-96.
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