重度妊娠高血压综合征肾脏损害的临床表现及病理转归  

Clinical and pathological features in patients with renal damage of serious pregnancy hypertension syndrome

作　　者：岳荣铮[1] 张凌[1] 付平[1] 徐缓[2] 

机构地区：[1]四川大学华西医院肾脏内科,四川成都610041 [2]四川大学华西医院病理科

出　　处：《西部医学》2010年第2期231-234,共4页Medical Journal of West China

摘　　要：目的总结重度妊娠高血压综合征肾脏损害患者的临床特点、肾活检病理改变特征及转归。方法对25例住院的重度妊娠高血压综合征肾脏损害患者中的16例在分娩后5d～半年行经皮肾穿刺活检病理检查。观察指标包括病程、临床表现、肾功能、尿液检查、肾活检病理、临床与病理联系及临床转归。结果临床表现均有高血压（i00％）和蛋白尿（100％），少部分患者伴有镜下血尿（12％）、血肌酐（SCr）升高（16．48％）、贫血（20％）。肾活检组织改变表现为肾小球内皮细胞增生（68．75％），肾小球局灶节段硬化（37．5％），内皮系膜增生性病变及基质病变（6．25％），系膜基质病变（6．25％），严重血管病变（16．48％）。终止妊娠后约50％患者血压下降，尿蛋白减少至转阴，但病理表现FSGS、血管病变较重者尿检异常持续存在。电镜观察是最可靠的诊断手段。结论重度妊娠高血压综合征肾脏损害患者临床主要表现为高血压、蛋白尿，部分患者出现镜下血尿，血肌酐升高。肾脏病理特征性表现以内皮细胞增生病变为主，其他表现包括系膜细胞增多、FSGS等。病理表现为FSGS和血管病变较重者预后相对较差。产后及时肾活检，安全性好，有助于早期确诊、指导治疗和判断预后。Objective To investigate the clinical and pathological features in patients with renal damage of serious pregnancy hypertension syndrome. Method Twenty five patients with preeclampsia and/or nephrotic syndrome, sixteen of them proved by renal biopsy, were retrospectively studied. The time of symptom appearing, onset symptoms, laboratory examinations and renal histology were analyzed. Results Their main clinical manifestations were severe hypertension （100%） and various degree of proteinuria （100%）. Pathological features of these patients were endothelial hyperplasia （68.75%）, focal and segmental glomerulsclerosis （37.5%, various degree of increasing in mesangial cell and matrix （6.25%）. Severe necrosis of arteriole was observed in 16.48%, accompanied by severe clinical course. After delivery, edema disappeared, hypertension improved and proteinuria ameliorated gradually in some of patients. However, proteinuria was last in some patients with focal and segmental glomerulosclerosis or severe lesion of arteriole. Conclusion The main clinical manifestations in patients with renal damage of serious pregnancy hypertension syndrome were hypertension and proteinuria. The endothelial hyperplasia was a specific histological feature, and in addition, increasing in mesangial cells and mesangialmatrix and focal and segmental glomerulosclerosis was often found. Prognosis was good, however, in the patients with focal and segmental glomerulosclerosis or severe lesion of arteriole was not so well.

关 键 词：重度妊娠高血压综合征 肾脏损害 先兆子痫 肾病综合征 肾活检 

分 类 号：R714.246[医药卫生—妇产科学] R692.6[医药卫生—临床医学]