强直性脊柱炎肾损害的临床病理特点  

Clinicopathological characteristics of renal diseases in patients with ankylosing spondylitis

作　　者：李铎[1] 谌贻璞[2] 张聪[1] 程虹[2] 陈文[1] 董鸿瑞[2] 邹万忠[3] 李文歌[1] 

机构地区：[1]卫生部中日友好医院肾内科,北京100029 [2]首都医科大学附属北京安贞医院肾内科 [3]北京大学医学部病理学系

出　　处：《临床肾脏病杂志》2010年第4期169-172,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨强直性脊柱炎（AS）合并肾损害的临床及病理特点。方法回顾性分析18例经肾脏活体组织检查的AS患者的临床及肾脏病理表现。结果18例患者中，9例呈隐匿性肾小球肾炎表现，5例呈慢性肾小球肾炎表现，1例呈肾病综合征表现，3例为慢性肾功能不全；4例血压增高，14例血压正常。24h尿蛋白定量平均为（1．17±1．39）g。15例肾功能正常，3例肾功能异常患者血肌酐平均为（153．2±36．8）umol／L。8例患者血清IgA水平升高，10例c反应蛋白升高，13例红细胞沉降率（EsR）增快，且血清IgA水平和C反应蛋白呈正相关（r=0．707，P=0．001），血清IgA水平和ESR呈正相关（r=0．858，P〈0．001）。病理检查结果发现15例为IgA肾病（其中10例为轻度系膜增生性肾炎，1例为轻度系膜增生性肾炎并慢性肾小管间质肾病，2例为局灶增生性肾炎，1例为局灶增生坏死性肾炎，1例为局灶节段性肾小球硬化症），1例为膜性肾病，1例为局灶增生性肾炎伴慢性肾小管间质肾病，1例为慢性。肾小管间质肾病。有慢性肾小管间质肾病者均有服中药史。结论AS相关性肾损伤的病理改变多样，但主要为IgA肾病，也可表现为膜性肾病、局灶增生性肾炎和慢性肾小管间质。肾病，其肾损伤可能与AS疾病本身和（或）治疗用药相关。Objective To analyze the clinicopathological characteristics of renal involvement in patients with ankylosing spondylitis （AS）. Methods Clinicopathological data of 18 patients with AS who were admitted to our hospital and subjected to renal biopsy in our department from 1999 to 2008 were retrospectively studied. Results Nine patients manifested with latent glomerulonephritis syndrome （asymptomatie hematuria or/and proteinuria）, 5 with chronic glomerulonephritis syndrome, ] with nephrotie syndrome, and 3 with chronic renal insufficiency. Four patients had hypertension. Eleven patients were normotensive. The average 24-h proteinuria was（ 1.17 ± 1.39）g. Fifteen patients had normal renal function. The average serum creatinine was （153.2 ± 36. 8）umol/L in 3 patients with renal function impairment. Serum IgA level was elevated in 8 patients. C-reactive protein（CRP） was increased in 10 patients and erythrocyte sedimentation rate （ESR） was increased in 13 patients. Serum IgA level was positively correlated with CRP（r = 0. 707, P = 0. 001 ）and ESR（r = 0. 858, P〈0. 001 ） respectively. IgA nephropathy （IgAN） was confirmed in 15 patients, in which 10 suffered from mild mesangial proliferative glomerulonephritis, one from mild mesangial proliferative glomerulonephritis accompanied with chronic tubulointerstitial nephropathy （CTIN）, two from focal proliferative glomerulo- nephritis, one from focal proliferative and necrotic glomerulonephritis, and one from focal segmental sclerosis. One case suffered from membranous glomerulopathy. There was one case of focal proliferative glomerulonephritis combined with CTIN, and one case of CTIN. All CTIN patients had taken Chinese herbal medicine. Conclusions IgAN might be the prominent pathological pattern in AS patients with renal abnormalities. CTIN in patients who had taken Chinese herbal medicine should not be neglected.

关 键 词：脊柱炎 强直性 肾小球肾炎 IGA C反应蛋白质 

分 类 号：R735.2[医药卫生—肿瘤]