不同性别原发性IgA肾病患者临床病理特征的对比分析
Clinical and pathological features of primary IgA nephropathy in patients of different gender

摘要：目的 探讨不同性别原发性IgA肾病患者的临床病理特点。方法 对经肾脏活检确诊的192例IgA肾病患者不同性别的临床表现、实验室检查及肾脏病理进行对比分析。结果 男性患者发病年龄高于女性，肾活检前病程长于女性，水肿的比例低于女性，差异有统计学意义(P<0.05)。肾脏穿刺时，男性平均动脉压、血红蛋白、24h尿蛋白定量高于女性，男性高血压、高尿酸血症、高甘油三酯血症比例高于女性；而男性肾小球滤过率(eGFR)低于女性，差异有统计学意义(P<0.05)。临床病理类型的性别分布差异有统计学意义(χ2=12.666，P<0.05)，均以U-ab型、MP型为主；24h尿蛋白、CKD分组的性别分布差异有统计学意义(Z=－3.118、Z=－3.246，P<0.05)。病理Lee分级、免疫荧光类型无性别分布差异(Z=－1.881，χ2=－0.187，P>0.05)；肾小管-间质病变分级(TIL分级)的性别分布差异有统计学意义(Z=－3.0432，P<0.05)；肾小球硬化评分、肾小管间质评分两指标均为男性高于女性(P<0.05)。结论 原发性IgA肾病患者临床和病理改变存在一定性别差异，男性患者临床病理改变较女性严重。
ABSTRACT: Objective To explore the clinical and pathological features of primary IgA nephrology in patients of different gender. Methods The clinical manifestations, laboratory examination and renal pathology results were compared in 192 IgA nephrology patients. Results Not only the onset age of the male patients was older than that of the female ones (P<0.05), but also the course of disease before the kidney biopsy of male patients was longer than that of the female ones (P<0.05). Besides, the proportion of edema in the male patients was lower (P<0.05). The mean arterial pressure, hemoglobin and 24h urine protein levels were higher in the male patients at the time of kidney biopsy. Besides, the proportions of high blood pressure, hyperuricemia and hypertriglyceridemia were all higher in the male patients. Furthermore, eGFR of the male patients was lower than that of the female ones (P<0.05). There was a significant difference in the gender distribution of clinical and pathological types (χ2=12.666，P<0.05), and the male and female patients also significantly differed in the 24h urine protein and CKD grouping (Z=－3.118, Z=－3.246，P<0.05). However, there was no significant sex difference in Lee pathology grading or immunofluorescence type (Z=－1.881, χ2=－0.187, P>0.05). Patients of different gender significantly differed in the renal-interstitial lesions grading (Z=－3.0432, P<0.05); to be more specific, the scores of glomerulosclerosis and renal tubule interstitia were higher in the male patients (P<0.05). Conclusion Patients of different gender differ in the clinical and pathological features of primary IgA nephrology. And clinical pathology of male patients is worse than that of female ones