肾小管间质损害在IgA肾病中的临床意义

目的：探讨肾小管间质损（TIL）在IgA肾病（IgAN）中的临床意义。方法：分析609例IgAN患者的临床与病理资料。结果：肾小管间质损害情况，肾小管间质损害轻度占47．1％，中度者占21．7％，重度者占16．6％，无肾小管间质损害者仅占14．6％。肾小管间质损害与临床指标的关系；随着肾小管间质损害程度的加重。IgAN患者的病情亦逐渐加重，表现为知血压升高，尿蛋白定量增加，血清白蛋白下降及肾功能减退。肾小管间质损害与病理参数的关系。血管损害、肾小球总体损害、系膜增殖程度及球性硬化的积分随着肾小管间质损害程度的加重逐渐增高，反之，随着肾小球和血管病变的加重，肾小管间质损害程度亦相应加重，结论：肾小管间质损害在IgAN患者病理改变中广泛存在，并随其损害程度的加重，IgAN患者的病情亦逐渐加重，肾小管间质损害可能是决定IgAN预后不良的关键因素之，且其与肾小球及血管病程度均呈平行关系，从而提示肾小管间质害与肾小球和血管的病变有直接的关系。

Clinical analysis of tubulointerstitial lesions in IgA nephropathy

Objective To analyze the characteristics of tubulointerstitial lesions(TIL)in IgA nephropathy (IgAN). Methods The pathologic and clinical materials of 609 IgAN patients were analyzed. Results (1) Prevalence characteristics of TIL:Among all the patients, these with mild TIL accounted for 47 1%, moderate TIL 21 7%, severe TIL was about 16 6% and these without TIL 14 6% (2) Relationship between TIL and the clinical findings : With increase of the severity of TIL , hypertension became worse and the level of proteinuria increased gradually On the contrary, serum albumin decreased and renal function degraded (3) Relationship between TIL and the pathologic findings : With increase of the severity of TIL , the scores of vascular lesion, total glomerular lesion, hypercellularity and glomerulosclerosis increased gradually Moreover, when the glomerular lesion and vascular lesion became worse, the severity of TIL also increased The relationship with the crescents was different, the score of the presence of crescents was highest when TIL was moderate in severity; it would not increase when TIL was severe Conclusion With the increase of the severity of TIL , the condition of IgAN patients became worse TIL may be one of the key factors for the prognosis of IgAN TIL is closely related to the severity of glomerular and vascular lesions, and these lesions may further lead to the development of TIL