狼疮性肾炎血管病变病理特点观察  

作　　者：滕舰[1] 刘立秋[2] 

机构地区：[1]烟台市烟台山医院,山东烟台264000 [2]青岛大学青岛医学院,山东青岛266000

出　　处：《实用医技杂志》2007年第22期2967-2969,共3页Journal of Practical Medical Techniques

摘　　要：目的:观察狼疮性肾炎(LN)肾间质血管病变病理特点,探讨其发病机制,以指导临床治疗。方法:选择狼疮性肾炎病人115例,诊断符合美国风湿病学会制定的诊断标准,均在B超引导下行经皮肾活检术,所有患者的光镜切片均行HE、PAS、PASM、Masson三色染色,光镜下观察血管病变特点;采用冰冻切片行免疫荧光直接法染色,观察IgG、IgA、IgM、C3、C4、C1q在肾小球、间质、血管的沉积情况。结果:依据光镜结果及免疫病理,将血管病变分为5种类型:1、血管免疫复合物沉积型(VICD);2、非炎症性坏死(NNV);3、栓塞性微血管病变(TMA);4、真性血管炎(TRV);5.硬化性血管病变(SVC)。各型光镜病理特点、免疫荧光及临床表现均有不同。结论:LN肾血管病变各型除形态学改变不同,其发病机制也存在差异,VICD和NNV均认为与免疫复合物沉积或原位形成有关,而内皮细胞损伤是TMA发生的基础。血管病变的类型不同常导致不同的临床表现并影响治疗及预后。Objective To investigate pathological characteristics of intrarenal vascular lesions in patients with lupus nephritis （LN） and to explore the pathogenesy,so to direct clinical treatment.Methods： One hundred and fifteen patients with lupus nephritis （LN） were enrolled in the study , who were diagnosed by the ACR （American College of Rheumatology） diagnostic criteria,renal, All the biopsies were performed through uhrasonographie detector lead the way.All the light microscope slices were treated by HE, PAS.PASM and Masson staining ,then the characteristics of vascular lesions were observed by light microscope; the frozen sections were treated by direct method of immunofluoreseenee staining , then the deposition conditions of IgG、IgA、IgM、C3、C4、C1q within glomerulus、renal interstitium、vaseellum was observed.Results： According to the renal vascular lesions , five subgroups were divided . They are vascular immune complex deposits （VICD） , noninflammatory necrotizing vasculopathy （NNV）, thrombotic microangiopathy （TMA）, true renal vasculitis （TRV）, sclerotic vascular changes （SVC）. They differed in pathologic charateristics,immunofluorescence features and clinical manifestation.conclusions： There are differences between subgroups of LN not only in morphology but also in pathogenesis. It is believed that , VICD and NNV are related to immunocomplex deposition and formation in situ, and endotheliocyte injury is the pathologic base of TMA. Different types of vascular lesions often lead to diverse clinical manifestations, and also influence therapy and prognosis.

关 键 词：狼疮性肾炎 血管病变 病理特点 

分 类 号：R593.242[医药卫生—内科学]