高血压肾硬化症致病因素的初步探讨  

The preliminary study on the pathogenic factors of hypertensive nephrosclerosis

作　　者：程虹[1] 谌贻璞[1] 邹万忠[1] 陈文[1] 董鸿瑞[1] 谭敏[1] 

机构地区：[1]卫生部中日友好医院肾病中心,北京100029

出　　处：《临床肾脏病杂志》2006年第5期197-200,F0003,共5页Journal Of Clinical Nephrology

摘　　要：目的初步探讨高血压肾硬化症致病因素。方法对临床及病理检查确诊的28例高血压肾硬化症患者进行回顾性分析，用统计学方法检验各指标间相关关系。结果可见部分人球小动脉玻璃样变或／（和）小叶间动脉肌内膜增生，包括管壁增厚小动脉约占（20．3±15．6）％，部分肾小球呈缺血性病变，包括缺血性皱缩约占（20．5±18.0）％，及缺血性硬化约占（16．0±14．2）％，且管壁增厚小动脉数与缺血性皱缩肾小球数及全部缺血性肾小球数均呈显著正相关（前者7=0．445，P〈0．05；后者γ=0．576，P〈0．01）。并未发现代谢因素（体重、血糖、血脂或血尿酸）与肾脏病理改变及肾功能间存在相关关系（P〉0．05）。结论本结果提示高血压肾硬化症的主要致病因素仍是高血压诱发的肾脏血流动力学变化，积极控制高血压是防治肾损害的关键。Objective To investigate the possible pathogenic factors of hypertensive nephrosclerosis. Method Twenty eight cases of hypertensive nephrosclerosis were studied. Retrospective survey of clinicopathlogical data, including semiquantitative pathological examination on renal specimens was performed. Then, the statistical correlation analysis between clinical and pathologic parameters was done. Results The hyalinosis of afferent arteriole or/and myointimal hyperplasia of interlobular arteriole were seen （the percentage of sclerotic arterioles was 20.3 ± 15.6）%. The ischemic glomeruli with wrinkling basement membrane （20. 5± 18.0）% or with complete collapse of capillary tuft （16. 0 ± 14. 2）% were also found. There were significant correlations between sclerotic arterioles and ischemic glomeruli with wrinkling basement membrane （γ= 0. 445, P = 0. 018） or total ischemic glomeruli （γ= 0. 576, P = 0. 001 ）. No significant correlations between metabolic factors （body mass index, serum glucose, triglyceride, cholesterone, and uric acid） and renal pathologic findings or renal functions were detected. Conclusions The principal pathogenic factor of hypertensive nephrosclerosis is still the changes of renal hemodynamics caused by hypertension, so rigorous treatment of hypertension making the blood pressure to target value is very important to prevent hypertensive nephroselerosis.

关 键 词：高血压肾硬化症 致病机制 临床-病理分析 

分 类 号：R692.9[医药卫生—泌尿科学]