• 解放軍沈陽(yáng)軍區(qū)總醫(yī)院腎內(nèi)科（沈陽(yáng)，110016）;

【摘要】　目的　 探討IgA腎病腎血管病變的危險(xiǎn)因素。　方法　 回顧性分析2000年1月－2009年6月間經(jīng)腎活檢確診的175例IgA腎病患者資料，其中有腎血管病變者93例，無(wú)腎血管病變者82例，進(jìn)行對(duì)照研究。采用多因素非條件logistic回歸模型分析影響IgA腎病腎血管病變的危險(xiǎn)因素。　結(jié)果　 高血壓[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）]、腎小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、腎間質(zhì)纖維化[OR=4.880，P=0.014，95%CI（1.385，17.199）]對(duì)IgA腎病腎血管病變的影響有統(tǒng)計(jì)學(xué)意義。　結(jié)論　 高血壓、24 h尿蛋白定量、血肌酐、腎小球硬化和腎間質(zhì)纖維化可能是影響IgA腎病腎血管病變的獨(dú)立危險(xiǎn)因素。積極控制以上危險(xiǎn)因素對(duì)延緩IgA腎病病變的進(jìn)展具有重要意義。
【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.

引用本文： 關(guān)欣,鄭紅光. IgA腎病腎血管病變危險(xiǎn)因素的非條件logistic回歸分析. 華西醫(yī)學(xué), 2011, 26(8): 1121-1124. doi: 復(fù)制

1. 　Donadio JV. Recent advances in IgA nephropathy[J]. Kidney Int, 2009, 76(10): 1015-1016.
2. 　宋立群, 劉道銀, 宋業(yè)旭. IgA腎病中醫(yī)藥研究進(jìn)展[J]. 光明中醫(yī), 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. 　張欣, 吳慧娟, 萬(wàn)鵬, 等. 腎血管病變?cè)?IgA腎病病理中的意義[J]. 中國(guó)醫(yī)學(xué)創(chuàng)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, 劉志宏. 中國(guó)腎臟病學(xué)[M]. 3版. 北京: 人民軍醫(yī)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例原發(fā)性IgA腎病的臨床與病理及相關(guān)性分析[J]. 中國(guó)中西醫(yī)結(jié)合腎病雜志, 2010, 11(5): 434-436.
12. 　路杰, 許勇芝, 黃志清, 等. IgA腎病308例臨床與病理分析[J]. 中華全科醫(yī)學(xué), 2011, 9(4): 525-527.
  1. 1. 　Donadio JV. Recent advances in IgA nephropathy[J]. Kidney Int, 2009, 76(10): 1015-1016.
  2. 2. 　宋立群, 劉道銀, 宋業(yè)旭. IgA腎病中醫(yī)藥研究進(jìn)展[J]. 光明中醫(yī), 2010, 25(3): 536-537.
  3. 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. 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. 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. 6. 　張欣, 吳慧娟, 萬(wàn)鵬, 等. 腎血管病變?cè)?IgA腎病病理中的意義[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2009, 6(8): 9-11.
  7. 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. 8. 　黎磊石, 劉志宏. 中國(guó)腎臟病學(xué)[M]. 3版. 北京: 人民軍醫(yī)出版社, 2008: 447.
  9. 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. 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. 11. 　施珍, 潘殊方, 谷定英, 等. 121例原發(fā)性IgA腎病的臨床與病理及相關(guān)性分析[J]. 中國(guó)中西醫(yī)結(jié)合腎病雜志, 2010, 11(5): 434-436.
  12. 12. 　路杰, 許勇芝, 黃志清, 等. IgA腎病308例臨床與病理分析[J]. 中華全科醫(yī)學(xué), 2011, 9(4): 525-527.