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目的:了解血管病变在IgA肾病(IgAN)与系膜增殖性肾小球肾炎(MsPGN)及膜性肾病(MN)中的不同特点。方法:回顾性分析1005例IgAN患者、627例MsPGN患者和221例MN患者血管病变的发生率、病变程度及病变类型。结果:1005例IgAN患者、627例MsPGN患者和221例MN患者肾活检组织中血管病变的发生率分别为54.6%,26.6%和47.1%,血管病变发生的平均年龄分别为34.6,40.4和47.7岁,中/重度血管病变的比例分别为37.0%,21.6%和23.1%,合并血管玻璃样变的比例分别为43.7%,16.8%和21.2%,上述4项指标三者之间均存在明显差异(P<0.05)。在IgAN患者中,有高血压者出现血管壁增厚合并玻璃样变的比例明显高于无高血压者(P<0.001)。结论:IgAN患者较MsPGN及MN患者血管病变的发生比例高,出现的年龄轻、程度重,合并玻璃样变的比例高。在IgAN患者中高血压的发生可能与血管的玻璃样变关系密切。
Objective: To understand the different characteristics of vascular lesions in IgA nephropathy (IgAN) and mesangioproliferative glomerulonephritis (MsPGN) and membranous nephropathy (MN). Methods: A retrospective analysis of 1005 cases of IgAN patients, 627 cases of MsPGN patients and 221 cases of MN patients with vascular disease incidence, degree of lesion and type of lesions. Results: The incidences of vascular lesions in renal biopsies of 1005 patients with IgAN, 627 patients with MsPGN and 221 patients with MN were 54.6%, 26.6% and 47.1%, respectively. The mean age of vascular lesions were 34.6, 40.4 and 47.7 years , And the rates of moderate / severe vascular lesions were 37.0%, 21.6% and 23.1%, respectively, and the proportions of vascular vitreous changes were 43.7%, 16.8% and 21.2% respectively. There were significant differences among the above four indexes P <0.05). In patients with IgAN, there was a significantly higher rate of vascular wall thickening with hyaline degeneration in hypertensive patients than in those without hypertension (P <0.001). CONCLUSIONS: IgAN patients have a higher proportion of vascular lesions than MsPGN and MN patients, with younger age, heavier weight, and higher rates of combined vitreous changes. The occurrence of hypertension in IgAN patients may be closely related with the vitreous changes of blood vessels.