【摘要】 目的探讨IgA肾病(IgAN)预后与肾脏病理组织学改变、尿蛋白及其变化的关系。方法根据10年间Ccr变化情况将135例IgAN分为3组:肾功能稳定组(66例)、肾功能进展组(33例)、透析组(36例);按照初期Ccr不同分为肾功能正常组(112例)和肾功能降低组(23例),观察10年间各组Ccr变化情况;初期肾功能、尿蛋白、病理组织学改变,病程中的尿蛋白变化、蛋白尿≥1 g/d且持续时间占整个观察时间的比例等与预后的关系。结果10年间3组Ccr均降低,稳定组、进展组、透析组分别为10 ml/min、40 ml/min、70 ml/min,尿蛋白的推移稳定组维持在0.5 g/d以下,进展组在1 g/d左右,透析组在1.5 g/d左右。初期Ccr<70 ml/min的病例,尿蛋白多、组织学损害明显的其预后不良,与肾功能正常组比较差异有统计学意义;Ccr≥70 ml/min的病例,初期尿蛋白≥1 g/d的与尿蛋白<1 g/d组比较差异有统计学意义。无论组织学损害程度如何,如果临床过程中尿蛋白≥1 g/d,并且持续的时间超过整个观察时间40%以上的病人以后肾功能降低的可能性大。结论对尿蛋白持续>1 g/d的患者将尿蛋白降低至1 g/d以下对稳定肾功能是有积极意义的,如果降低至0.2~0.5g/d以下意义将更大。更多还原

【Abstract】 Objective To investigate the IgA nephropathy(IgAN) and renal prognosis of histopathological changes,changes in urine protein and relationship between them.Methods According to changes in Ccr in the past 10 years,divided 135 cases of IgAN into 3 groups: the stable renal function group(66 cases),the enhanced renal function group(33 cases),dialysis group(36 cases);in accordance with the Ccr level divided into normal renal function group(112 cases) and reduced renal function group(23 cases),observation of changes in Ccr in each group in the past 10 years;initial renal function,urine protein,histopathological changes,in the course of urine protein changes,relationship betweenin proteinuria ≥ 1g/d,the proportion of the total observation time to duration etc.and prognosis.Results Over the past decade,Ccr of 3 groups all decreased,the stable renal function group,the enhanced renal function group,dialysis group(36 cases) were 10ml/min,40ml/min,70ml/min,the stable renal function group maintained lower than 0.5g/d,the enhanced renal function group maintained at around 1g/d,dialysis group maintained at around 1.5g/d.In the initial,the cases which Ccr <70ml/min,with high urine protein level and obvious histological damage,their prognosis were poor,Compared with the normal renal function group,the differences possess statistically significant;In the initial the cases which Ccr ≥70ml/min,the differences between the group urine protein ≥1g/d and the group urine protein <1g/d possess statistically significant.Regardless of the degree of histological damage,if the urine protein ≥1g/d,nd over the entire duration of more than 40% of observation time,the renal function reduced is more likely in the future.Conclusion Make the patient which urine protein sustained more than 1g/d reduced to below 1g/d,is more positive for stabilize renal function,if reduced to 0.2-0.5g/d,will be a greater significance.更多还原