冷球蛋白血症肾损害的超微结构特征及其诊断意义  

Ultrastructural features of cryoglobulinemia related glomerulonephritis and its diagnostic value

作　　者：王素霞[1] 邹万忠[2] 王盛兰[2] 张烨[1] 王书合[1] 汤秀英[1] 

机构地区：[1]北京大学第一医院电镜室,北京100034 [2]北京大学医学部病理学系,北京100083

出　　处：《电子显微学报》2005年第6期558-563,共6页Journal of Chinese Electron Microscopy Society

摘　　要：为探讨冷球蛋白血症肾损害的超微结构特征及其在本病诊断中的作用,对冷球蛋白血症肾损害的肾活检标本进行系统的电镜超微结构观察,并分析其临床、病理特点及超微结构的改变。12例冷球蛋白血症肾损害病例中,原发性冷球蛋白血症5例,继发性冷球蛋白血症7例。膜增生性肾小球肾炎是其最常见的病理类型,其次为非典型膜性肾病及毛细血管内增生性肾小球肾炎;可见肾小球内皮细胞下及毛细血管腔内大量嗜复红蛋白沉积形成白金耳或微血栓样结构。电镜检查可见肾小球内的电子致密物形成多种有形结构,包括微管状、纤维状、晶格样及颗粒样结构等,主要分布于肾小球内皮细胞下及毛细血管腔内,也可见于上皮细胞下、基底膜内及系膜区;并可见毛细血管腔内含大量吞噬溶酶体的单核细胞浸润。肾组织内形成特殊有形结构的电子致密沉积物是冷球蛋白血症肾损害的突出超微结构特征,在冷球蛋白血症肾损害的诊断中具有重要意义。To investigate the ultrastruetural features of cryoglobulinemia related glomerulonephritis and its diagnostic value, the renal biopsy from the patients diagnosed as cryoglobulinemia related glomerulonephritis were examined by electron microscopy, and their clinical data, renal pathological features and ultrastructural morphology were analysed. Among 12 cases who were diagnosed as cryoglobulinemia related glomerulonephritis,5 cases were essential cryoglobulinemia,the other 7 cases were secondary cryoglobulinemia. The main pathological pattern of cryoglobulinemia related glomerulonephritis was membranoproliferative glomerulonephritis, the others included atypical membranous nephropathy and endocapillary proliferative glomeruloinephritis. Glomerular subendothelial deposits and intraluminal thrombi were demonstrated in these cases. Organized electron-dense deposits were identified by electron microscopy, the deposits organized into microtubular, fibrillary, crystalline-like and granular structures, and were demonstrated mainly in subendothelia and capillary lumen; the similar organized structures were also identified in mesangial, subepithelial and intramembranous deposits. Besides, endocapillary monocytes with large droplets of phagolysosomes were observed. Glomerular organized electron-dense deposits were the prominent ultrastructural features of cryoglobulinemia related glomerulonephritis, and possessed an important value in the diagnosis of this disease.

关 键 词：冷球蛋白血症 肾脏疾病 电子显微镜 超微结构 有形结构沉积物 

分 类 号：R692[医药卫生—泌尿科学]