目的:通过对IgA肾病(IgAN)及糖尿病肾病(DN)患者心血管疾病(CVD)患病情况及常见CVD危险因素的观察分析,比较这两类常见肾脏疾病患者CVD的预测指标的差异。方法:收集2009年10月至2011年10月南京军区南京总医院全军肾脏病研究所住院及门诊随访的所有经肾活检确诊为IgAN及DN资料完整的患者病史及实验室检查结果,根据有无合并CVD将IgAN和DN患者分为CVD组和非CVD组,比较两组患者一般临床资料和实验室检查指标,分析这两类常见肾脏疾病CVD危险因素差异。结果:IgAN患者181例,DN患者199例,IgAN组患者较DN组显著年轻,高血压发生率、体质量指数(BMI)、血红蛋白(Hb)、血胆固醇(TC)明显低于DN组。IgAN患者慢性肾脏病(CKD)2～5期时CVD患病率分别为8.7%,7.7%,17.2%及44.4%,总CVD患病率19.9%,其中冠状动脉疾病(CAD)患病率为0.6%,左心室肥厚(LVH)为14.9%,充血性心力衰竭(CHF)为5.6%。DN患者CKD2～5期时CVD患病率分别为29.6%、40.0%、45.2%及72.7%,总CVD患病率43.7%,其中CAD患病率16.1%,LVH为33.2%,CHF为8.5%。DN患者CKD各期的CVD患病率均显著高于IgAN患者(CKD2期为29.6%vs8.7%,P<0.01,CKD3期为40.0%vs7.7%,P<0.01,CKD4期为45.2%vs17.2%,P<0.05,CKD5期为72.7%vs44.4%,P<0.05)。DN患者CAD、LVH发生率均明显高于IgAN(CAD16.1%vs0.6%,P<0.01,LVH33.2%vs14.7%,P<0.01)。IgAN及DN患者CKD5期CVD患病率均较CKD2～4期明显升高。IgANCVD组患者高血压发生率、SCr及血磷水平明显高于非CVD组,Hb水平明显低于非CVD组。DNCVD组患者吸烟率、高血压发生率、血清肌酐(SCr)及TC水平明显高于非CVD组。多因素回归分析提示IgAN患者并发LVH的独立危险因素是SCr及Hb(OR值分别为1.22,P<0.05;0.67,P<0.01),而DN患者并发LVH的独立危险因素是SCr及BMI(OR值分别为1.77,P<0.01;1.36,P<0.05),并发CAD的独立危险因素是吸烟、SCr及血LDL水平升高(OR值分别为2.96,P<0.05;1.45,P<0.01;6.93,P<0.05)。结论:DN患者在CKD各期CVD患病率均高于IgAN患者,两组患者的CVD均以LVH最常见,但DN组CAD、LVH发生率均明显高于IgAN,其中CAD患病率升高尤为明显,提示可能与DN患者CVD死亡率高有关。两组CKD5期患者CVD患病率均迅速升高,提示CKD患者CVD防治应及早进行。IgAN患者CVD发病可能与肾脏疾病相关危险因素更为密切,而糖尿病合并多种代谢异常等非肾脏病相关危险因素可能对DN患者CVD发病影响更大。 OBJECTIVE: To compare the prevalence of cardiovascular disease (CVD) and risk factors of CVD in patients with IgA nephropathy (IgAN) and diabetic nephropathy (DN) and to compare the predictive value of CVD in these two common renal diseases. Methods: The data of all patients with IgAN and DN diagnosed by renal biopsy from October 2009 to October 2011 in Nanjing General Hospital of Nanjing Military Region were enrolled in the hospital and outpatient follow-up. The patients’ history and laboratory findings were collected according to Patients without IgA and DN without CVD were divided into CVD group and non-CVD group. The clinical data and laboratory indexes of two groups were compared. The differences of CVD risk factors between these two groups of common kidney diseases were analyzed. Results: 181 cases of IgAN and 199 cases of DN patients were significantly younger than those of DN group. The incidence of hypertension, body mass index (BMI), hemoglobin (Hb) and blood cholesterol (TC) were significantly lower than those of DN group. The prevalence of CVD in stage 2 ~ 5 of patients with chronic kidney disease (CKD) in IgAN was 8.7%, 7.7%, 17.2% and 44.4% respectively, and the prevalence of CVD was 19.9%. The prevalence of coronary artery disease (CAD) 0.6%, left ventricular hypertrophy (LVH) 14.9% and congestive heart failure (CHF) 5.6%. The prevalence of CVD in patients with DN at CKD stage 2-5 were 29.6%, 40.0%, 45.2% and 72.7%, respectively. The prevalence of CAD was 43.7%. The prevalence of CAD was 16.1%, LVH was 33.2% and CHF was 8.5% . The prevalence of CVD in patients with DN was significantly higher than that in patients with IgAN (29.6% vs 8.7% in CKD2, P <0.01, 40.0% vs.7.7% in CKD3, P <0.01, 45.2% vs17.2%, P <0.05, CKD5 was 72.7% vs44.4%, P <0.05). The incidence of CAD and LVH in patients with DN was significantly higher than that of IgAN (CAD16.1% vs0.6%, P <0.01, LVH33.2% vs14.7%, P <0.01). The prevalence of CVD in CKD stage 5 in IgAN and DN patients was significantly higher than that in CKD stage 2 ~ 4. The incidence of hypertension, SCr and serum phosphorus in patients with IgANVD were significantly higher than those in non-CVD patients, and the levels of Hb in patients with IgANCVD were significantly lower than those in non-CVD patients. The smoking rate, the incidence of hypertension, serum creatinine (SCr) and TC in DNCVD group were significantly higher than those in non-CVD group. Multivariate regression analysis showed that the independent risk factors of IgH complicated with LVH were SCr and Hb (OR = 1.22, P <0.05; 0.67, P <0.01). The independent risk factors of LVH complicated with LVH were SCr and BMI Values ​​were 1.77, P <0.01; 1.36, P <0.05). The independent risk factors of CAD were smoking, SCr and blood LDL levels (OR = 2.96, P <0.05; , P <0.05). Conclusions: The prevalence of CVD in patients with DN is higher than that in patients with IgAN in all stages of CKD. The CVD of LVH is the most common in both groups, but the incidence of CAD and LVH in DN group is significantly higher than that of IgAN, and the prevalence of CAD is increased Particularly obvious, suggesting that may be associated with high CVD mortality in patients with DN. CVD prevalence in both CKD5 patients were rapidly increased, suggesting that CVD prevention and treatment of CKD patients should be carried out as soon as possible. The incidence of CVD in IgAN patients may be associated with risk factors associated with kidney disease more closely, and non-kidney disease-related risk factors such as diabetes complicated with metabolic disorders may have a greater impact on CVD patients with DN.