摘要
目的探讨儿童IgA肾病(IgAN)高尿酸血症的临床、病理特征及危险因素。方法回顾性分析2006年1月1日至2017年12月31日于中山大学附属第一医院小儿肾病中心确诊原发性IgAN儿童269例,分高尿酸血症组(血尿酸>350μmol/L)和正常尿酸组,比较两组的临床及病理特征,行多因素Logistic回归分析伴发高尿酸血症的危险因素。结果269例IgAN患儿中男性185例,女性84例,年龄(9.2±3.1)岁,其中伴发高尿酸血症者有70例(26.0%)。高尿酸血症组患儿的高血压比例、尿素氮、血肌酐、血脂、尿蛋白量均高于正常尿酸组(均P<0.05),估算肾小球滤过率、血清总蛋白、白蛋白均低于正常尿酸组(均P<0.05)。CKD 1~2期和3~5期IgAN患儿中伴发高尿酸血症者分别为58例(23.0%)和12例(70.5%),CKD3~5期IgAN患儿中伴高尿酸血症者比例高于正常尿酸组(P<0.01)。高尿酸血症组Lee病理分级IV、V级比例高于正常尿酸组(均P<0.05)。根据牛津病理分型评分,两组在系膜细胞增生、毛细血管内增生、节段硬化及粘连、肾小管萎缩/间质纤维化及新月体形成方面差异无统计学意义(均P>0.05)。根据Katafuchi半定量法评分,两组间肾脏病变总积分、肾小球评分、肾小管间质评分的差异无统计学意义(均P>0.05),但高尿酸血症组肾血管评分高于正常尿酸组(P<0.01)。多因素Logistic回归分析示,伴高血压(OR=12.596,95%CI 1.778~89.243,P=O.011)、高胆固醇(OR=1.192,95%CI 1.064~1.336,P=0.002)、高BUN(OR=1.273,95%CI 1.104~1.468,P=O.001)、蛋白尿3+和4+(OR=1.875,95%CI 1.309~2.684,P=0.001;OR=1.627,95%CI 1.241~2.134,P<0.001)、CKD 3期(OR=3.355,95%CI 1.376~8.181,P=0.008)是IgAN患儿伴发高尿酸血症的危险因素。结论26.0%IgAN患儿伴发高尿酸血症,其临床表现及病理改变相对正常尿酸组更严重。高血压、高胆固醇、高BUN、蛋白尿3+和4+、CKD 3期是IgAN患儿伴发高尿酸血症的危险因素。
Objective To investigate the clinical,pathological features and risk factorsof hyperuricemia in children with IgA nephropathy (IgAN).Methods A retrospective study of 269 primary IgAN children diagnosed between January 1,2006 to December 31,2017 at the Children Kidney Disease Center,the First Affiliated Hospital of Sun Yat-sen University,was performed in the hyperuricemia group (uric acid >350 μmol/L)and the normal uric acid group.The clinical and pathological characteristics were analyzed,and the risk factors of hyperuricemia were analyzed by using multivariate logistic regression analysis.Results There were 185 males and 84 females in the 269 IgAN children with age of (9.2±3.1)years old,among whom there were 70 patients (26.0%) accompanied by hyperuricemia.Clinical indicators such as hypertension,urea nitrogen,serum creatinine,blood lipids,urinary protein in hyperuricemia group were higher than those in normal uric acid group (all P<0.05),while estimated glomerular filtration rate,serum total protein and albumin were less (all P<0.05).There were 58 patients (23.0%)and 12 patients (70.5%)associated with hyperuricemia among IgAN children with CKD 1-2and CKD 3-5.The proportion of hyperuricemia in CKD stage 3-5 IgAN children was statistically higher than that in normal uric acid group (P <0.01). The hyperuricemia group had a higher proportion of Lee IV and V grade,and a lower proportion of the Lee Ⅲ grade than the normal uric acid group (all P <0.05).According to the Oxford pathological classification score,there was no significant difference in total scores of renal lesions,glomerular score, and tubulointerstitial score between the two groups (all P>0.05).According to the Katafuchi semiquantitative score,there was no significant difference in the total scores of renal lesions,glomeruli,and tubulointerstitial scores (all P>0.05),while the hyperuricemia group had higher renal vascular scores than the normal uric acid group (P <0.01).Multivariate logistic regression analysis showed that hypertension (OR=12.596,95% CI 1.778-89.243,P=0.011),higher total cholesterol (OR=1.192,95% CI 1.064-1.336,P=0.002),higher urea nitrogen (0R=1.273,95% CI 1.104-1.468,P=0.001),proteinuria 3+ (OR=1.875,95%CI 1.309-2.684,P=0.001),proteinuria 4+(OR=1.627,95%CI 1.241-2.134,P <0.001) and CKD stage 3(0R=3.355,95% CI 1.376-8.181,P=0.008)were the risk factors of hyperuricemia in children with IgAN.Conclusions Twenty-six percent IgAN children patients are accompanied by hyperuricemia,and their clinical parameters and pathological changes are more severe than those in normal uric acid group.Hypertension,higher total cholesterol,higher urea nitrogen,proteinuria 3+/4+ and CKD stage 3 are the risk factors of hyperuricemia in children with IgAN.
作者
邓洞
陈丽植
林知朗
杨帆
李获菁
姜梦婕
许园园
莫樱
蒋小云
Deng Jiong;Chert Lizhi;Lin Zhilang;Yang Fan;Li Dying;Jiang MengJie;Xu Yuanyuan;Mo Ying;Jiang Xiaoyun(Children Kidney Disease Center,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2018年第12期893-899,共7页
Chinese Journal of Nephrology
基金
国家自然科学基金(81670648)
广东省科技计划项目(2016A020215033)
广东省自然科学基金(2015A030313045)
广东省医学科研基金项目(A2015302)
广州市科技计划项目(201607010284).
作者简介
通信作者:蒋小云,Email:xyjiang-3208@163.com。Corresponding author:Jiang Xiaoyun,Email:xyjiang-3208@163.com
