ABSTRACT:Objective To explore the relationship between clinical manifestations and pathological changes in patients with IgA nephrophathy.Methods To compare the clinical pathological data of 300 patients with primary IgA nephrophathy,who were diagnosised in the Shaanxi Chinese Hospital from Jan.2008 to Dec.2012.Results① The young and middle-aged had the highest incidence of IgA nephrophathy, about 9 0%, hematuria and proteinuria was the primary clinical manifestations among all ages,the incidence of hypertension and abnormal renal function was higher among 60-year age,about 29.3% and 28%.② The IgA+IgM deposition measured by immunofluorescence was the most common pathological type(3 6%).The ratio of IgA deposition was higher in LeeⅠ-Ⅲ of IgA nephrophathy,while IgA+IgM deposition was more common in Lee Ⅳ and Ⅴ (45.5% and 81.8%). The deposition of C3 was common in all IgA nephrophathy(6 3 .3%).③ Lee Ⅰ-Ⅳ grades were the more common grades,covered over 96.3%.Hematuria and proteinuria were the primary clinical manifestations inⅠ-Ⅴpathological changes grading.The incidence of hematuria,proteinuria,hematuria with proteinuria,and hypertension had no significant difference in all pathologic grading,but abnormal renal function had significant difference in Lee Ⅴ(P<0 .0 5 ).④ Abnormal of urine protein and RBC did not have significant difference in Lee Ⅰ-Ⅴ;C3 depositions in serum had significant difference in Ⅳ pathologic grading(P<0 .0 5 ).The elevation of IgA in serum had significant difference in Lee Ⅴ(P<0 .0 5 ).The proportion of abnormal serum creatinine(SCr)increased with the pathological grades,showing a rising trend.Conclusion IgA nephropathy has the characteristics of diversification of clinical manifestations and pathology changes. The incidences of hematuria, proteinuria and hypertension in IgA nephrophathy patients have no correlation with pathological grading;but with pathological grade promotion,the incidence of abnormal renal function increases.%目的：探讨IgA肾病患者的临床表现与病理特征之间的相关性。方法对陕西省中医院肾病科2008年1月至2012年12月间确诊为原发性 IgA肾病的300例患者的临床病理资料进行研究分析。结果①中青年组发病比例最高(90%)；各年龄段均以血尿、蛋白尿为主要临床表现。高血压、肾功异常在≥60岁组发生率最高,分别为29.3%和28%。②免疫荧光IgA+IgM病理类型所占比例最高(36%),其次为单纯性IgA(29.7%)、IgA+IgM+IgG(17.7%)、IgA+IgG(16.7%)。Ⅰ~Ⅲ级分型中免疫荧光单纯 IgA所占比例最高；在 IV 和Ⅴ级中以 IgA+IgM沉积所占比例最高,分别为45.5%、81.8%。所有 IgA 肾病中表现为 C3沉积的比例较高,为63.3%。③肾组织病理改变分级以Lee分级Ⅰ~Ⅳ为主,占96.3%。Ⅰ~Ⅴ级病理改变的临床表现均以血尿、蛋白尿为主,相比其他临床表现更多见(P<0.05),各病理分级中血尿、蛋白尿、血尿合并蛋白尿、高血压发生率无显著性差异,而肾功能异常的比例以Ⅴ级为著,其差异具有统计学意义(P<0.05)。④Ⅰ~Ⅴ级病理改变中尿 RBC、尿蛋白异常所占比例无显著差异；病理类型Ⅳ级血清中C3下降最显著(P<0.05)；病理类型Ⅴ级病例血清中 IgA 升高的比例最低,其差异具有统计学意义(P<0.05)。而血清中肌酐异常的比例随着病理类型分级的升高,呈逐渐上升趋势,以病理类型Ⅴ级血清肌酐异常的比例最高。结论 IgA肾病具有临床表现、病理改变多样化等特点,IgA 肾病血尿、蛋白尿和高血压的发生率与病理分级无相关性,但随着病理分级的升高,肾功能异常的发生率增高。
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