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目的探讨影响乙型肝炎病毒相关性肾炎(HBV-GN)高血压发生的相关因素。方法对HBV-GN的临床病理资料227例进行回顾性病例对照研究,运用单因素及多因素方法分析其高血压发生与临床病理因素的关系。结果有高血压者49例,总发生率21.6%。随估算的肾小球滤过率(eGFR)下降,其高血压发生率逐渐升高。单因素分析发现年龄≥30岁、病程≥60月、高尿酸血症、血肌酐≥132.6μmol/L、高胆固醇血症、系膜增生程度大于等于中度、肾小球硬化率≥50%、伴有新月体形成、肾小管间质病变大于等于Ⅱ级、免疫复合物同时沉积于系膜区及血管袢者共10个因素为其影响因素。单纯蛋白尿型高血压发生率较高,而单纯血尿型未出现高血压。膜增生性肾炎、硬化型肾小球肾炎与局灶节段性肾小球硬化者高血压发生率较高(P<0.01)。多因素Logistic回归分析显示年龄、高胆固醇血症、系膜增生程度及肾小管间质病变程度等4个因素是HBV-GN高血压发生的独立影响因素。结论HBV-GN是继发性高血压常见的病因之一,其高血压发生与肾功能减退、高胆固醇血症、系膜增生程度及肾小管间质病变程度等有关。
Objective To explore the factors influencing the occurrence of hypertension in patients with hepatitis B virus associated nephritis (HBV-GN). Methods A retrospective case-control study was performed on 227 cases of clinical and pathological data of HBV-GN. The relationship between hypertension and clinicopathological factors was analyzed by univariate and multivariate analysis. The results of hypertension in 49 cases, the total incidence of 21.6%. As estimated glomerular filtration rate (eGFR) decreased, its incidence of hypertension increased gradually. Univariate analysis found that age ≥30 years of age, duration of 60 months, hyperuricemia, serum creatinine ≥ 132.6μmol / L, hypercholesterolemia, mesangial hyperplasia was greater than or equal to moderate glomerular sclerosis ≥ 50% With the formation of crescent, tubulointerstitial lesions greater than or equal to Ⅱ level, immune complexes deposited in the mesangial area and blood vessels were a total of 10 factors for its influencing factors. The incidence of simple proteinuria is high, while that of simple hematuria is not high. Membrane proliferative glomerulonephritis, sclerosing glomerulonephritis and focal segmental glomerulosclerosis were associated with a higher incidence of hypertension (P <0.01). Logistic regression analysis showed that age, hypercholesterolemia, mesangial hyperplasia and tubulointerstitial lesion were the four independent factors influencing the occurrence of hypertension in HBV-GN. Conclusions HBV-GN is one of the common causes of secondary hypertension. The incidence of hypertension is related to renal dysfunction, hypercholesterolemia, mesangial hyperplasia and tubulointerstitial lesions.