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目的探讨IgA肾病发生慢性肾功能不全的相关危险因素。方法选取1997—2006年广西医科大学附属第一医院肾内科384例IgA肾病患者,按血肌酐水平,分为肾功能正常组(320例)和肾功能不全组(64例),对比分析两组患者临床病理资料,多元回归分析探寻影响患者肾功能的相关危险因素。结果男性、水肿、高血压、蛋白尿发生率在肾功能不全组显著增多(P<0.05),以蛋白尿发生率最高(OR=6.14);与肾功能正常组相比,年龄、血压、尿蛋白水平、血IgA等多项参数差异均有显著性意义(P<0.05),但病程长短差异无显著性意义;免疫沉积物半定量分析显示,仅IgG的沉积两组间比较差异有显著性意义,且是肾功能正常组高于肾功能不全组(P<0.01),IgA、IgM、C3、C4、C1q和FG的沉积比较差异均无显著性意义(P>0.05)。病理评分各指标在肾功能不全组均显著增高(P<0.01)。回归分析显示,与血肌酐水平相关的参数按影响力大小依次是硬化指数、尿蛋白、性别等。结论影响肾功能最危险的因素是蛋白尿,其余依次为男性和高血压,年龄大、血IgA水平高和严重的肾脏病理改变也是肾功能预后差的相关指标;病程长短不是肾功能不全进展的必要条件,肾脏免疫复合物可能也不是肾功能不全的可靠标志。
Objective To investigate the related risk factors of IgA nephropathy with chronic renal insufficiency. Methods 384 patients with IgA nephropathy who were admitted to Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University from 1997 to 2006 were divided into two groups according to the level of serum creatinine: normal renal function group (320 cases) and renal insufficiency group (64 cases) Clinicopathological data, multiple regression analysis to explore the impact of renal function related risk factors. Results The incidence of male patients with edema, hypertension and proteinuria was significantly higher in patients with renal insufficiency (P <0.05) and the highest incidence of proteinuria (OR = 6.14). Compared with normal renal function group, age, Protein level, blood IgA and other parameters were significantly different (P <0.05), but the course of disease duration was no significant difference; semi-quantitative analysis of immune sediment showed only IgG deposition between the two groups were significantly different (P <0.01). There was no significant difference in the deposition of IgA, IgM, C3, C4, C1q and FG between the normal renal function group and the renal dysfunction group (P> 0.05). Pathological score of each index in renal insufficiency group were significantly higher (P <0.01). Regression analysis showed that the parameters related to the level of serum creatinine were sclerotic index, urinary protein, sex and so on according to the influencing factors. Conclusions The most dangerous factor affecting renal function is proteinuria. The rest followed by male and high blood pressure. Age, high level of blood IgA and severe renal pathological changes are also related indicators of poor prognosis of renal function. The duration of disease is not the progression of renal insufficiency Necessary conditions, renal immune complexes may not be a reliable indicator of renal insufficiency.