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目的探讨拟诊高血压肾硬化(HN)患者的临床特征及影响预后的因素,以期提高临床对该病诊断及治疗的认识。方法回顾性分析我科63例最初拟诊HN且有肾活检诊断的患者的临床资料。根据肾脏病理学结果分为原发性肾炎(PN)组、良性肾小动脉硬化症(BN)组及恶性肾小动脉硬化症(MN)组,比较各组间临床参数及组织学特征。对确诊HN的患者分析影响其预后的临床及病理因素。结果 63例临床拟诊为HN的患者经肾组织活检病理诊断,37例 (58．7％)为BN;12例(19．0％)为MN;14例(22．2％)为PN,HN诊断符合率为77．7％。BN组患者男性较多,年龄较大,高血压家族史比例及高血压病程明显高于PN组,而PN组尿蛋白定量高于BN及MN组。MN组左心室心肌重量指数(LVMI)高于PN组。BN组视网膜病变主要为0-Ⅱ级,占78％,而MN组则主要为Ⅲ～Ⅳ级。PN组球性硬化肾小球比率及小管慢性化指数(CI)积分均高于MN及BN组。MN及BN组肌内膜细胞增殖、小动脉玻璃样变等血管病变均较PN组明显,其中BN组改变最为显著。多因素回归分析提示收缩压(SBP)、尿蛋白定量、尿酸(UA)、总胆固醇(TC)是影响肾脏病进展的危险因素,优势比分别为2．563、2．467、2．323、2．357。结论临床拟诊HN的患者不能排除PN。部分HN与PN患者临床表现相似,单纯依据病史及实验室检查难以区分。肾组织病理检查是确诊的最佳手段。SBP、尿蛋白、TC、UA等因素可加速HN的病变进展。
Objective To investigate the clinical characteristics of patients with hypertensive nephrosclerosis (HN) and prognostic factors in order to improve the clinical diagnosis and treatment of the disease awareness. Methods Retrospective analysis of 63 cases of our department initially diagnosed HN with renal biopsy in patients with clinical data. According to the results of nephrology, the patients were divided into primary nephritis (PN) group, benign atherosclerosis (BN) group and malignant atherosclerosis (MN) group. The clinical parameters and histological features were compared between the groups. Patients with confirmed HN were analyzed for clinical and pathological factors that influence their prognosis. Results Thirty-three HN patients diagnosed by pathology were diagnosed by renal biopsy, 37 cases (58.7%) were BN, 12 cases (19.0%) were MN, and 14 cases (22.2% The coincidence rate of HN diagnosis was 77.7%. BN group patients were more male, older, family history of hypertension and hypertension course was significantly higher than the PN group, while the quantitative determination of urinary protein in PN group BN and MN group. MN group left ventricular myocardial mass index (LVMI) higher than the PN group. The retinal lesions in BN group were mainly grade 0-II, accounting for 78%, while those in MN group were mainly grade III-IV. PN glomerular sclerosis ratio and tubulointerstitial (CI) score were higher than MN and BN group. MN and BN group endometrial cell proliferation, arteriolar hyaline degeneration and other vascular lesions were significantly more than the PN group, in which BN group the most significant change. Multivariate regression analysis showed that systolic blood pressure (SBP), urinary protein, uric acid (UA) and total cholesterol (TC) were the risk factors for the progression of renal disease. The odds ratios were 2.563, 2.467, 2.323, 2.357. Conclusions Patients with clinically suspected HN can not rule out PN. Some HN and PN patients with similar clinical manifestations, based solely on medical history and laboratory tests is difficult to distinguish. Renal histopathology is the best method of diagnosis. SBP, urinary protein, TC, UA and other factors can accelerate the progression of HN lesions.