目的:分析肥胖相关性肾病(ORG)患者肾小球滤过率(GFR)影响因素。方法:26例经临床和肾活检明确诊断为ORG的患者,男性22例,女性4例,平均年龄(37.12±9.42)岁,平均体重指数(BMI)(29.99±2.99)kg/m2。以体表面积校正内生肌酐清除率(Ccr)反应GFR,根据Ccr值不同分3组:A组:Ccr≥120ml/min·m2,B组:Ccr80～120ml/min·m2,C组:Ccr<80ml/min·m2。比较三组临床一般情况、血脂和血尿酸水平、糖代谢指标的差异,同时比较肾活检组织学改变(肾小球肥大、球性/节段硬化的发生率以及内皮细胞病变程度等)。按照内皮细胞病变程度分为:无内皮细胞病变、轻度内皮细胞病变(<20%的肾小球见内皮细胞肿胀、增生)和重度内皮细胞病变(>20%的肾小球见内皮细胞肿胀、增生,并可见内皮性泡沫细胞)。分析内皮细胞病变程度和Ccr高低之间的关系。结果:三组体重指数比较无显著差异,C组患者病程最短。三组患者平均肾脏体积均增大,A组增大最明显。C组尿蛋白量和血肌酐水平最高。C组三酰甘油、三酰甘油/高密度脂蛋白胆固醇水平最高,其次分别为B组和A组,三组比较差异显著。糖耐量异常三组比较无明显差异。三组患者均存在高胰岛素血症,C组胰岛素抵抗值显著高于其他两组。A组合并内皮细胞病变比例最多(90.9%),但在病变程度上,C组重度内皮细胞病变患者所占比例最高(66.7%)。A组患者以OGM所占比例最多(63.64%),其球性硬化和节段硬化比例均低于B组和C组,组间比较无显著性差异。结论:①ORG患者Ccr升高组伴双肾体积增大,提示该部分患者确实存在肾小球高滤过和高灌注。②ORG患者Ccr升高与BMI异常增高的程度无关联,Ccr升高组、Ccr正常组和降低组之间BMI无显著差异。③未发现高胰岛素血症,胰岛素抵抗,高尿酸血症和高脂血症与Ccr变化之间存在相关关系。④Ccr下降组胰岛素抵抗状态尤为突出,同时内皮细胞病变重,提示胰岛素抵抗与ORG患者肾功能恶化有关,而内皮细胞病变轻重可能有助于预后判断。 Objective: To analyze the influencing factors of glomerular filtration rate (GFR) in obesity-associated nephropathy (ORG). METHODS: Twenty-six patients with ORG diagnosed as clinically and biochemically confirmed, 22 were male and 4 were female, with an average age of (37.12 ± 9.42) years and a mean body mass index (BMI) of 29.99 ± 2.99 kg / m2. According to the value of Ccr, GFR was divided into three groups: group A: Ccr≥120ml / min · m2, group B: Ccr80 ~ 120ml / min · m2, group C: Ccr < 80ml / min · m2. The clinical general conditions, blood lipid, serum uric acid level and glucose metabolism indexes were compared among the three groups. Histological changes of renal biopsy (glomerular hypertrophy, incidence of pelvic / segmental sclerosis and endothelial cell lesion) were also compared. According to the degree of endothelial cell lesions are divided into: no endothelial cell lesions, mild endothelial cell lesions (<20% of glomerular see endothelial cell swelling, hyperplasia) and severe endothelial cell lesions (> 20% of glomerular endothelial cell swelling , Hyperplasia, and endothelial cells can be seen). Analysis of the relationship between the degree of endothelial cell lesions and the level of Ccr. Results: There was no significant difference in body mass index among the three groups, and the shortest duration was found in group C. Three groups of patients with an average renal volume increased, A group increased the most obvious. C group, the highest amount of urinary protein and serum creatinine. C group triglyceride, triglyceride / high-density lipoprotein cholesterol highest level, followed by group B and group A, the three groups were significantly different. Impaired glucose tolerance three groups no significant difference. All three groups had hyperinsulinemia, and the insulin resistance in group C was significantly higher than the other two groups. In group A, the proportion of endothelial cell lesions was the highest (90.9%), but the degree of lesion was the highest (66.7%) in group C with severe endothelial cell lesions. The proportion of patients with OGM in group A was the highest (63.64%), and the ratio of sclerosis and segmental sclerosis in group A was lower than that in group B and C, there was no significant difference between the two groups. Conclusions: ① The elevated Ccr group with enlarged renal tubules in patients with GC, suggesting that there is indeed glomerular hyperfiltration and high perfusion in these patients. ② There was no association between the elevated Ccr and the abnormal increase of BMI in patients with ORG. There was no significant difference in BMI between Ccr elevated group and normal Ccr group. ③ No hyperinsulinism, insulin resistance, hyperuricemia and hyperlipidemia were found to correlate with Ccr changes. ④Crr descending group of insulin resistance is particularly prominent, while endothelial cell disease, suggesting that insulin resistance and ORG patients with impaired renal function, and endothelial cell lesions may contribute to the prognosis.