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目的探讨局灶增生型免疫球蛋白A(Ig A)肾病的临床病理及痰瘀互结的特点。方法对肾活检确诊为局灶增生型Ig A肾病36患者的临床病理资料以及中医特点进行分析。结果局灶增生型Ig A肾病以血尿、蛋白尿为主要表现,部分出现e GFR下降及Cys C升高。光镜下均见系膜细胞和基质弥漫性轻至中度增生,局灶节段加重,系膜区嗜复红蛋白沉积。中医的标证以血瘀证多见;而兼证以痰瘀互结多见。结论局灶增生型Ig A肾病应该重视对蛋白尿、e GFR、Cys C等指标的监测。应该重视病理特点,尽早发现预后不良因素。
Objective To investigate the clinicopathological characteristics of focal proliferative immunoglobulin A (IgA) nephropathy and the characteristics of phlegm and blood stasis. Methods The clinical and pathological data of 36 patients with focal proliferative IgA nephropathy confirmed by renal biopsy and the characteristics of TCM were analyzed. Results Focal proliferative IgA nephropathy mainly manifested as hematuria and proteinuria. Some of them showed decreased e GFR and increased Cys C. Light microscopy showed mesangial cells and stromal diffuse mild to moderate hyperplasia, focal segmental aggravating mesangial deposition of hemoglobin. Chinese medicine certificate to blood stasis more common; and concurrent evidence of phlegm and blood stasis more common. Conclusion Focal proliferative IgA nephropathy should pay attention to the monitoring of proteinuria, e GFR, Cys C and other indicators. Should pay attention to the pathological features, early detection of adverse prognostic factors.