iga肾病与过敏性紫癜性肾炎的临床和病理对比分析

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1、IgA肾病与过敏性紫癜性肾炎的临床和病理对比分析作者：周长华蔡林祥朱月文居建析徐宏【摘要】目的对比研究有新月体形成（<50%）的IgAN肾病(IgAN)和过敏性紫癜性肾炎(HSPN)在临床及肾脏病理改变上的异同，探讨两者的关系。方法对经肾活检证实的病理上有<50%新月体形成的25例IgAN及23例HSPN成人（>18岁）进行临床及病理对比分析。结果IgAN和HSPN临床表现相似，高血压、血尿、蛋白尿、尿NAG酶升高等发生率差异均无显著性（P>0.05）；IgAN肾功能损害程度较重，两者的血肌酐水平差异有显著性（

2、P<0.05）；IgAN和HSPN肾脏的组织病理检查，节段新月体形成率和球囊粘连、内皮增生、节段硬化等发生率差异均无显著性（P>0.05），而袢坏死、球性硬化、肾间质纤维化、肾小管萎缩发生率差异均有显著性（P<0.05）；两组免疫病理均以IgA在系膜区沉积为主（伴或不伴血管袢的沉积），沉积差异无显著性（P>0.05）。结论IgAN与HSPN两者在高血压、血尿、蛋白尿发生率等临床表现差异无显著性，但IgAN肾功能减退明显，肾组织发生球性硬化、间质纤维化、小管萎缩等慢性化病变较重。【关键词】IgA肾病过敏性紫癜性肾

3、炎新月体临床和病理10　　【Abstract】ObjectiveTocomparetheclinicalandpathologicalcharactersisticsinpatientswithcrescentic(<50%)IgAnephropathy(IgAN)andHenoch-Schonleinpurpuranephritis(HSPN).Thepresentstudyaimedtocharacterizetheirrelationshipthroughclinicopathologicalcomparisonbetwe

4、enIgANandHSPN.Methods25adultwithIgANand23adultwithHSPNinthisstudy.Theirclinicalmanifestations,bloodbiochemicaltest,renalpathologicalfindingsinlightmicroscopyandimmunofluorescencewereanalyzedandalsocomparedbetween25IgANand23HSPN.ResultTheclinicalpatternsofIgANandHSPNwere

5、similar.Hypertension/hematuria(severeandmirror)/proteinuriaandurineNAGenzymaticarisingwerenotsignificant(P>0.05).ButinIgAN,renalfunctionwasdamagedbadlyandtheserumcreatininewassignificantlyhigherthanthatinHSPN(P<0.05).Pathologicalexamination,suchassegmentalcrescent

6、s/glomeruli-Bowman'scapsuleadhesion/endothelialproliferationandsegmentsclerosiswerefoundsimilarlyinIgANandHSPNpatients(P>0.05).Whiletheglobalsclerosis/renalinterstitialfibrosisandtubularatrophyweremarkedlyhigherinIgANthanthatinHSPNpatients(P<0.05).Capillarynecrosi

7、swaslowerinIgANthaninHSPNpatients(P<0.05).All10thecasesinbothgroupshadIgAdepositioninglomerulus.Nosignificantdifferencewasfoundthedepositionsof,IgG,IgM.C3,C4andC1qonglomerulusbetweentwogroups(P>0.05).ConclusionsTheclinicalpatternsofIgAnephropathyandHSPNweresimilar

8、.Whilethepathologicalchangessuchasrenaldysfunction,globalsclerosis,renalinterstitiumfibrosisandtubularatrophyw