论文部分内容阅读
目的 探讨肾功能不全伴肾实质厚度变薄患者肾活检的临床病理特征及诊断价值/风险比.方法 收集肾功能不全患者临床病理、超声及并发症资料,并以超声下所测得右肾实质厚度15 mm作为标准,将研究对象分为正常右肾实质厚度组(简称正常组)与右肾实质厚度变薄组(简称变薄组),t检验(或U检验)和卡方检验进行统计学比较分析临床资料和病理结果,非条件Logistic回归模型分析主要并发症(需要输血或外科手术/动脉栓塞治疗等)的危险因素.结果 变薄组显示出较低的肾小球滤过率[28.0 (15.9,40.9)vs.36.8(17.4,48.2)ml/(min× 1.73 m2),P =0.049]、较少的24h尿总蛋白定量[(2.8(1.2,4.9) vs.3.7(1.5,8.1)g/d,P=0.048]和较高的血清白蛋白[33.7(27.6,39.2)vs.28.7(18.8,36.0) g/L,P=0.001].继发性肾小球疾病在变薄组较低(12.7％ vs.24.6％,P=0.037).变薄组肾小球总硬化比＞50％ (40.7％ vs.15.9％,P＜0.001)、肾小管萎缩(83.1％ vs.60.9％,P=0.001)、间质炎症细胞浸润伴纤维化(80.5％ vs.60.9％,P=0.003)、小动脉玻璃样变性(53.4％ vs.36.2％,P=0.023)均高于正常组.非条件Logistic回归模型对主要并发症分析结果回示:舒张压P=0.016,OR=1.089,95％ CI:1.016 ～1.167;血肌酐P=0.031,OR=1.006,95％ CI:1.001～1.011.结论 变薄组病理表现出更多的小球硬化和间质纤维化;舒张压、血肌酐可能是影响主要并发症的独直危险因素,两组之间主要并发症的发生无显著差异.“,”Objective To explore the clinicopathological features and risk of renal biopsy in renal insufficiency patients with reduced renal parenchymal thicknesses.Methods The clinical,renal histopathologic,kidney dimensions in ultrasonography and complication data in renal insufficiency patients were collected.And the patients were divided into two groups according to the RPT value of 15mm,the normal RPT group and the reduced RPT group.t test (or a U test) and chi-square tcst were used to compare the clinical and pathological variables.Unconditional Logistic regression model were used to analysis the risk factors of the adverse events with renal biopsy.Results The patients in the reduced RPT group showed less eGFR[28.0 (15.9,40.9) vs.36.8(17.4,48.2) ml/(rmin × 1.73 m2),P =0.049] and lower total urine protein[(2.8 (1.2,4.9) vs.3.7 (1.5,8.1) g/Day,P =0.048],higher serum albumin [33.7 (27.6,39.2) vs.28.7(18.8,36.0) g/L,P =0.001],respectively.The ratio of secondary glomerular diseases was lower in the reduced RPT group (12.7％ vs.24.6％,P =0.037).In the reduced RPT group,the ratio of total glomerular sclerosis ＞ 50％ (40.7％ vs.15.9％,P ＜ 0.001),renal tubular atrophy (83.1％ vs.60.9％,P =0.001),interstitial inflammatory cell infiltration with fibrosis (80.5％ vs.60.9％,P =0.003),and small artery vitreous degeneration (53.4％ vs.36.2％,P =0.023),were higher than the normal RPT group,respectively.Analysis of multivariate unconditional Logistic regression model to major complication showed,diastolic blood pressure P =0.016,OR =1.089,95％ CI:1.016-1.167;Serumcreatinine P =0.031,OR =1.006,95％ CI:1.001-1.011.Conclusion The patients with the reduced RPT show more glomerular sclerosis and interstitial fibrosis.Diastolic blood pressure and serum creatinine may be independent risk factors for major complications,major complications between the two groups are no significance.