IgA肾病合并高血压病88例临床病理特点分析

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摘要目的：研究合并高血压病的原发性IgA肾病（IgAN）的临床病理特点。方法：对2007年1月-2013年6月在我院肾内科经肾活检证实为IgAN且临床诊断高血压病的88例患者的临床病理资料进行回顾性分析。结果：IgAN合并高血压病患者平均年龄（44.7±11.27）岁。其中有高血压家族史48例，占54.5%。高血压病史（中位数为36个月）长于IgAN病史（中位数为2个月），P＜0.01。临床表现主要为无症状尿检异常，共66例（占75.0%）；其次是肾病综合征和慢性肾炎（分别占10.2%和11.4%）。肾小球滤过率估算值（eGFR）＜90 mL/min 29例（占33.0%），其中伴低尿渗透压6例（6/9），伴尿N-乙酰-β-D氨基葡萄糖苷酶（NAG）升高21例（21/29）；伴左室壁增厚和（或）左房增大52例（52/87）；伴高血压视网膜病变76例（76/80）。肾活检病理显示Haas 1级～3级病变合计占87.5%，重度肾小球硬化占19.3%，中重度肾间质病变占34.1%，肾细小动脉病变占78.4%。结论：合并高血压病的IgAN患者肾脏临床病理表现多数较轻；部分存在肾小球滤过功能异常者多合并肾小管功能异常，部分病例较重的肾小管间质病变与肾小球病变程度不平行，普遍存在肾细小动脉病变。对于合并高血压病的IgAN病例而言，高血压可能是影响肾脏预后的主要因素。

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	陈倩倩
	黄朝兴

关键词 ： IgA肾病, 高血压病, 病理学, 临床, 继发性高血压

Abstract：Objective: To study the clinical and pathological features of primary IgA nephropathy (IgAN) combined with primary hypertension in 88 cases. Methods: A retrospective case series of 88 patients who were diagnosed as IgAN by renal biopsy and diagnosed with primary hypertension by clinical in our hospital between January 1997 to June 2013. Results: The mean age of the 88 cases of IgAN with hypertension was (44.7±11.27) years. Their hypertension history (median 36 months) was longer than IgAN’s (2 months). Forty-eight cases had family hypertension history, accounting for 54.5%. Sixty-six cases (75.0%) showed asymptomatic urine abnormalities, followed by 10.2% nephrotic syndrome and 11.4% chronic nephritis. Among the 29 cases (33.0%) of renal dysfunction (eGFR<90 mL/min), there were 6 cases (6/9) with the low-gravity urine and 21 cases (21/29) with the high NAG enzyme urine. Among the 88 cases, 52 cases (52/87) had the left ventricular wall thickening and (or) left atrial enlargement change, and 76 cases (76/80) had hypertension retinopathy. The renal biopsy showed Haas 1～3 grade level together accounted for 87.5% of lesions, severe glomerular sclerosis accounted for 19.3%, cases of moderate to severe renal interstitial disease accounted for 34.1%, and renal small artery disease accounted for 78.4%. Conclusion: The clinical and pathological manifestations of IgAN combined with hypertension patients are mostly mild; the cases of low eGFR mostly complicated with renal tubular dysfunction; the renal biopsy shows most glomerular lesion is mild, whereas the renal tubulo-interstitial and renal artery lesion is severe.Some cases show that tubulointerstitial lesions and glomerular lesions do not parallel, and the renal small artery lesions are exist. In IgAN patients with hypertension, the blood pressure may be the main factor to affect the renal prognosis.

Key words： IgA-nephropathy hypertension pathology clinical secondary hypertension

收稿日期: 2015-06-23

通讯作者: 黄朝兴，主任医师，Email：huangzhaoxing@medmail.com.cn。

作者简介: 陈倩倩（1985-），女，浙江绍兴人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2016/V46/I3/199

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