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目的:比较原发性IgA肾病(IgA nephropathy,IgAN)合并代谢综合征(metabolic syndrome,MS)与未合并MS患者的临床及病理表现,分析MS对IgAN的影响,从而为IgAN合并MS患者治疗方案的选择提供依据。方法:选取2006年1月～2012年6月在南京医科大学附属无锡市人民医院行肾穿刺病理诊断为IgAN的病例453例,其中IgAN-MS组87例,IgAN-非MS组366例。检测两组患者的肾功能、尿蛋白及各代谢指标,分析各代谢指标与肾功能及尿蛋白的关系,并根据不同病理诊断标准对病理结果进行比较。结果:IgAN-MS组的尿蛋白定量、血清肌酐均显著高于IgAN-非MS组(P<0.05);IgAN-MS组的病理改变显著重于IgAN-非MS组(P<0.05)。Pearson相关性分析显示肾小球滤过率与24 h尿蛋白、平均动脉压、年龄、体质指数、甘油三酯呈负相关,24 h尿蛋白与空腹血糖、体质指数、血清白蛋白、甘油三酯、低密度脂蛋白胆固醇、尿酸呈正相关。Spearman相关分析显示MS与Lee氏分级及牛津分型的系膜细胞增生、毛细血管内增生、节段性肾小球硬化各项损伤评分均呈正相关。结论:MS是IgAN进展的危险因素,代谢指标异常可加重IgAN的肾损害。
OBJECTIVE: To compare the clinical and pathological features of primary IgA nephropathy (IgAN) with metabolic syndrome (MS) and non-combined MS and to analyze the effect of MS on IgAN so as to provide a therapeutic option for patients with IgAN and MS The basis for the choice. Methods: From January 2006 to June 2012, 453 cases of IgAN diagnosed by renal biopsy in Wuxi City People’s Hospital affiliated to Nanjing Medical University were selected, including 87 cases in IgAN-MS group and 366 cases in IgAN-non-MS group. The renal function, urinary protein and each metabolic index of two groups of patients were detected. The relationship between each metabolic index and renal function and urinary protein was analyzed. The pathological results were compared according to different pathological diagnostic criteria. Results: The urinary protein and serum creatinine in IgAN-MS group were significantly higher than those in IgAN-non-MS group (P <0.05). The pathological changes in IgAN-MS group were more significant than those in IgAN-non-MS group (P <0.05). Pearson correlation analysis showed that GFR was negatively correlated with 24 h urinary protein, mean arterial pressure, age, body mass index, triglyceride, 24 h urinary protein and fasting blood glucose, body mass index, serum albumin, Ester, low density lipoprotein cholesterol, uric acid were positively correlated. Spearman correlation analysis showed that there was a positive correlation between MS and Lee’s grading and Oxford classification of mesangial cell proliferation, capillary hyperplasia, segmental glomerulosclerosis damage scores. Conclusion: MS is a risk factor for the progression of IgAN. Abnormal metabolism may aggravate IgAN renal damage.