摘要
目的探讨不同类型血脂异常对儿童IgA肾病(IgAN)临床及病理特征的影响。方法回顾性分析2006年1月至2019年9月于中山大学附属第一医院小儿肾病中心确诊为原发性IgAN的患儿资料。按血脂是否正常分为血脂异常组和血脂正常组;按临床分类将血脂异常组分为以下4组:高胆固醇血症组、高三酰甘油血症组、混合性高脂血症组及低高密度脂蛋白-胆固醇(HDL-C)血症组,分析比较各组的临床及病理特征,并采用Logistic回归分析法分析IgAN患儿伴发血脂异常的相关危险因素。结果本研究共纳入IgAN患儿252例,男169例,女83例,男/女比为2.04∶1,年龄为(9.3±3.1)岁,34.5%的IgAN患儿伴有高血压;其中血脂异常组170例(67.5%),血脂正常组82例(32.5%);按临床分类将血脂异常组分为高胆固醇血症组(58例,23.0%)、高三酰甘油血症组(16例,6.3%)、混合性高脂血症组(77例,30.6%)及低HDL-C血症组(19例,7.5%)。血脂异常组收缩压、舒张压、伴高血压的比例、血尿素氮、血尿酸及尿蛋白量均高于血脂正常组(均P<0.05),血清白蛋白、血IgA及估算肾小球滤过率(eGFR)水平均低于血脂正常组(均P<0.05)。慢性肾脏病(CKD)1期和CKD 2~5期IgAN患儿伴发血脂异常的比例分别为65.0%和84.4%,血脂异常组中CKD 2~5期所占比例高于血脂正常组(P<0.05)。血脂异常组Lee氏病理分级Ⅲ~V级所占比例高于血脂正常组(P<0.01)。牛津病理分型结果显示血脂异常组中M1(>50%肾小球系膜区出现系膜细胞增生)和E1(有毛细血管内增生)所占比例均高于血脂正常组(均P<0.05),两组在节段性肾小球硬化、肾小管萎缩或间质纤维化及新月体方面差异无统计学意义(均P>0.05)。不同类型血脂异常组间的比较结果显示,混合性高脂血症组中收缩压、舒张压、血尿酸及尿蛋白量均高于其他血脂异常组(均P<0.05),血清白蛋白水平低于其他血脂异常组(P<0.01)。牛津病理分型结果显示,高胆固醇血症组和混合性高脂血症组中E1所占比例较高(P<0.05)。多因素Logistic回归分析结果显示,伴高血压(OR=2.734,95%CI 1.327~5.632,P=0.006)和低血清白蛋白(OR=0.838,95%CI 0.791~0.889,P<0.001)是IgAN患儿伴发血脂异常的危险因素。结论本中心67.5%IgAN患儿伴发血脂异常,其临床表现及病理结构改变较血脂正常患儿严重,且以伴发混合性高脂血症的IgAN患儿更为明显。伴高血压及低血清白蛋白是IgAN患儿伴发血脂异常的危险因素。
Objective To investigate the impact of different type of dyslipidemia on clinical and pathological characteristics in children with IgA nephropathy(IgAN).Methods A retrospective study was performed at the Children Kidney Disease Center,the First Affiliated Hospital of Sun Yat-sen University between January 2006 to September 2019.Children diagnosed with primary IgAN was divided into dyslipidemia group and normal blood lipid group according to whether the blood lipid is normal,and was divided into the following four groups:hypercholesterolemia group,hypertriglyceridemia group,mixed hyperlipidemia group and low high-density lipoprotein cholesterol(HDL-C)group according to clinical classification.The clinical and pathological features in different groups were analyzed,and the risk factors of dyslipidemia were analyzed by using multivariate logistic regression analysis.Results A total of 252 children with IgAN were enrolled in this study,including 169 males and 83 females,with a male/female ratio of 2.04∶1 and an age of(9.3±3.1)years.Among them,34.5%IgAN children were complicated with hypertension,and 170 cases(67.5%)were in dyslipidemia group,82 cases(32.5%)in normal blood lipid group.According to clinical classification,the children in dyslipidemia group were divided into hypercholesterolemia group(58 cases,23.0%),hypertriglyceridemia group(16 cases,6.3%),mixed hyperlipidemia group(77 cases,30.6%)and low HDL-C group(19 cases,7.5%).The systolic blood pressure,diastolic blood pressure,proportion of hypertension,blood urea nitrogen,uric acid and urinary protein in dyslipidemia group were higher than those in normal blood lipid group(all P<0.05),and the levels of serum albumin,blood IgA and estimated glomerular filtration rate(eGFR)were less(all P<0.05).The proportion of IgAN children in chronic kidney disease(CKD)stage 1 and CKD stage 2-5 with dyslipidemia was 65.0%and 84.4%respectively,and the proportion of IgAN children with CKD stage 2-5 in dyslipidemia group was higher than that in normal group(P<0.05).The dyslipidemia group had a higher proportion of LeeⅢ-V grade than normal blood lipid group(P<0.01).The results of Oxford pathological classification showed that the proportions of M1 and E1 in dyslipidemia group were higher than those in normal lipid group(all P<0.05),and there was no significant difference in segmental glomerulosclerosis,tubular atrophy or interstitial fibrosis and crescent between the two groups(all P>0.05).The comparison results between groups with different types of dyslipidemia showed that systolic blood pressure,diastolic blood pressure,serum uric acid and urinary protein in the mixed hyperlipidemia group were higher than those in other groups(all P<0.05),and the serum albumin level was less(P<0.01).The results of Oxford pathological classification showed that the proportion of E1 in hypercholesterolemia group and mixed hyperlipidemia group was higher(P<0.05).Multivariate logistic regression analysis showed that hypertension(OR=2.734,95%CI 1.327-5.632,P=0.006)and low serum albumin(OR=0.838,95%CI 0.791-0.889,P<0.001)were the risk factors of dyslipidemia in children with IgAN.Conclusions In our center,67.5%IgAN children are accompanied by dyslipidemia.The clinical manifestations and pathological changes of these dyslipidemia children are more severe than those with normal blood lipid,and the IgAN children with mixed hyperlipidemia are more notable.Hypertension and low serum albumin are the risk factors of dyslipidemia in children with IgAN.
作者
许园园
文思佳
程程
陈丽植
莫樱
李雯
蒋小云
Xu Yuanyuan;Wen Sijia;Cheng Cheng;Chen Lizhi;Mo Ying;Li Wen;Jiang Xiaoyun(Children Kidney Disease Center,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Laboratory of Department of General Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2020年第8期609-617,共9页
Chinese Journal of Nephrology
基金
国家自然科学基金(81670648)
广东省自然科学基金(2019A1515010694)
中国博士后科学基金(2018M643323)
中山大学高校基本科研业务费青年教师培育项目(19ykpy65)。
