【摘要】 目的 探讨IgA肾病肾血管病变的危险因素。 方法 回顾性分析2000年1月－2009年6月间经肾活检确诊的175例IgA肾病患者资料，其中有肾血管病变者93例，无肾血管病变者82例，进行对照研究。采用多因素非条件logistic回归模型分析影响IgA肾病肾血管病变的危险因素。 结果 高血压[OR=11.593，P=0.001，95%CI（2.800，47.991）]、24 h尿蛋白定量[OR=1.754，P=0.001，95%CI（1.270，2.424）]、血肌酐[OR=1.005，P=0.001，95%CI（1.002，1.008）]、肾小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、肾间质纤维化[OR=4.880，P=0.014，95%CI（1.385，17.199）]对IgA肾病肾血管病变的影响有统计学意义。 结论 高血压、24 h尿蛋白定量、血肌酐、肾小球硬化和肾间质纤维化可能是影响IgA肾病肾血管病变的独立危险因素。积极控制以上危险因素对延缓IgA肾病病变的进展具有重要意义。
【Abstract】 Objective To explore the risk factors for renal vascular lesions in patients with immunoglobulin A (IgA) nephropathy. Methods We retrospectively analyzed the clinical data of 175 IgA nephropathy patients diagnosed through renal biopsy from January 2000 to June 2009. Among them, there were 98 cases of renal vascular lesions and 82 cases without renal vascular lesion. Controlled study between the two groups of patients were carried out. A multivariate unconditional logistic regression model was employed to analyze the risk factors for renal vascular lesions in IgA nephropathy patients. Results The following factors had significant correlations with renal vascular lesions in IgA nephropathy patients: hypertension [OR=11.593,P=0.001,95%CI (2.800, 47.991)], 24-hour urine protein level [OR=1.754,P=0.001, 95%CI (1.270, 2.424)], serum creatinine [OR=1.005,P=0.001, 95%CI (1.002, 1.008)], glomerulosclerosis [OR=8.341,P=0.000,95%CI (2.716, 25.610)], and renal interstitial fibrosis [OR=4.880,P=0.014, 95%CI(1.385,17.199)]. Conclusion Hypertension, 24-hour urine protein, serum creatinine, glomerulosclerosis and renal interstitial fibrosis were risk factors for renal vascular lesions in IgA nephropathy patients. It will be very significant to actively control all the above risk factors to prevent occurrence of renal vascular lesions.
Citation：
GUAN Xin,ZHENG Hongguang. An Unconditional Logistic Regression Analysis of the Risk Factors for Renal Vascular Lesions in Patients with Immunoglobulin A Nephropathy. West China Medical Journal, 2011, 26(8): 1121-1124. doi:
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Reich HN, Troyanov S, Scholey JW, et al.Remission of proteinuria improves prognosis in IgA nephropathy[J]. J Am Soc Nephrol, 2007, 18(12): 3177-3183.
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施珍, 潘殊方, 谷定英, 等. 121例原发性IgA肾病的临床与病理及相关性分析[J]. 中国中西医结合肾病杂志, 2010, 11(5): 434-436.
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路杰, 许勇芝, 黄志清, 等. IgA肾病308例临床与病理分析[J]. 中华全科医学, 2011, 9(4): 525-527.
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- 1. Donadio JV. Recent advances in IgA nephropathy[J]. Kidney Int, 2009, 76(10): 1015-1016.
- 2. 宋立群, 刘道银, 宋业旭. IgA肾病中医药研究进展[J]. 光明中医, 2010, 25(3): 536-537.
- 3. Walsh M, Sar A, Lee D, et al. Histopathologic features aid in predicting risk for progression of IgA nephropathy[J]. Clin J Am Soc Nephrol, 2010, 5(3): 425-430.
- 4. Tan Y, Zhang JJ, Liu G, et al. The level of urinary secretory immunoglobulin A(sIgA) of patients with IgA nephropathy is elevated and associated with pathological phenotypes[J]. Clin Exp Immunol, 2009, 156(1): 111-116.
- 5. Working Group of the International IgA Nephropathy Network and the Renal Pathology Society. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification[J]. Kidney Int, 2009, 76(6): 534-545.
- 6. 张欣, 吴慧娟, 万鹏, 等. 肾血管病变在 IgA肾病病理中的意义[J]. 中国医学创新, 2009, 6(8): 9-11.
- 7. Tang SC, Tang AW, Wong SS, et al. Long-term study of mycophenolate mofetil treatment in IgA nephropathy[J]. Kidney Int, 2010, 77(6): 543-549.
- 8. 黎磊石, 刘志宏. 中国肾脏病学[M]. 3版. 北京: 人民军医出版社, 2008: 447.
- 9. Goto M, Wakai K, Kawamura T, et al. A scoring system to predict renal outcome in IgA nephropathy: a nationwide10-year prospective cohort study[J]. Nephrol Dial Transplant, 2009, 24(10): 3068-3074.
- 10. Reich HN, Troyanov S, Scholey JW, et al.Remission of proteinuria improves prognosis in IgA nephropathy[J]. J Am Soc Nephrol, 2007, 18(12): 3177-3183.
- 11. 施珍, 潘殊方, 谷定英, 等. 121例原发性IgA肾病的临床与病理及相关性分析[J]. 中国中西医结合肾病杂志, 2010, 11(5): 434-436.
- 12. 路杰, 许勇芝, 黄志清, 等. IgA肾病308例临床与病理分析[J]. 中华全科医学, 2011, 9(4): 525-527.
