膜性肾病合并新月体形成的临床病理分析

发布时间：2018-03-07 14:51

本文选题：膜性肾病　切入点：新月体　出处：《医学研究生学报》2015年12期 　论文类型：期刊论文

【摘要】：目的膜性肾病(membranous nephropathy,MN)较少合并新月体形成,排除继发性MN、合并抗GBM肾炎、系统性血管炎、Ig A肾病后更鲜有报道。文中旨在探讨此类患者的临床病理特征。方法回顾性分析南京军区南京总医院肾脏科2005年4月至2014年3月间肾活检病理示特发性膜性肾病(idiopathic membranous nephropathy,IMN)合并新月体形成,并排除抗GBM肾炎、系统性血管炎、Ig A肾病后的53例患者(新月体组)。在同期无新月体形成的IMN患者中随机选取100例为对照组,比较组间临床、实验室指标及病理特点。结果 53例MN合并新月体患者合并高血压比例(47.2%)及肾功能不全比例(28.3%)明显高于对照组(19.0%、4.0%),差异有统计学意义(P0.05)。在接受血清抗磷脂酶A2受体(phospholipase A2receptor,PLA2R)检测的45例患者中,30例为阳性。肾组织病理示新月体组中位新月体比例为4.6%(1.8%~35.3%),且在中位球性硬化比例、节段硬化比例、袢坏死比例、间质纤维化/小管萎缩(interstitial fibrosis/tubular atrophy,IFTA)比例以及小动脉病变比例等方面均高于对照组,分别为(8.1%vs 0.0%)、(49.1%vs 16.0%)、(11.3%vs 0.0%)、(86.8%vs 54.0%)、(92.5%vs 65.0%)差异均有统计学意义(P0.05)。新月体组免疫荧光示C4阳性率低于对照组(5.7%vs 20.0%,P0.05)。短期随访新月体组未发现MN的继发因素,末次随访时血清蛋白、尿蛋白定量与对照组比较差异无统计学意义,近期预后较对照组差异无明显。结论 MN合并新月体形成较少见,需排除继发性MN或合并其他新月体性肾小球疾病可能。临床上常合并高血压、肾功能不全,肾组织球性硬化、节段硬化、袢坏死、IFTA及小动脉病变比例高,近期预后尚可。
[Abstract]:Objective membranous nephropathy (MN) is less associated with crescents, excluding secondary MNs, and associated with anti GBM glomerulonephritis. Systemic vasculitis was rarely reported after IgA nephropathy. The aim of this study was to investigate the clinicopathological features of these patients. Methods the pathological findings of renal biopsy from April 2005 to March 2014 in the Renal Department of Nanjing General Hospital of Nanjing military region were retrospectively analyzed. Idiopathic membranous nephropathy (membranous) associated with crescents, 53 patients with GBM nephritis and systemic vasculitis after Ig A nephropathy were excluded (crescent group). 100 cases of IMN patients without crescent formation were randomly selected as control group. Results 53 cases of MN with crescents with hypertension (47.2%) and renal insufficiency (28.310%) were significantly higher than the control group (19.0% 4.0%, P 0.05). 30 of 45 patients detected by phospholipase A2 receptor were positive. Renal histopathology showed that the ratio of crescents to crescents in the crescents group was 4.6% and 1.8%, and the ratio of median spherosclerotic sclerosis was 3.33%. The ratio of segmental sclerosis, loop necrosis, interstitial fibrosis/tubular atrophy / interstitial fibrosis/tubular atrophy and arteriopathy were higher than those in control group. The difference was statistically significant (P < 0.01). The positive rate of immunofluorescence in the crescent group was lower than that in the control group (5.7 vs 20.0 P0.05). No secondary factors of MN were found in the crescent body group, but serum protein was not found at the last follow-up. There was no significant difference in urinary protein quantification compared with control group, and there was no significant difference in short-term prognosis compared with control group. Conclusion MN combined with crescene formation is rare. It is necessary to exclude the possibility of secondary MN or other crescent glomerular diseases. It is often associated with hypertension, renal insufficiency, glomerular sclerosis of renal tissue, segmental sclerosis, high proportion of ANSA necrosis IFTA and arterioles lesion, and the short term prognosis is good.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05) 江苏省科技创新与成果转化(生命健康)专项资金(BL2012007)
【分类号】：R692

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