抗肾小球基底膜肾炎临床及病理特征研究  

Clinical and pathological features of anti-glomerular basement membrane nephritis

作　　者：张艺艳[1,2] 唐政[1,2] 陈莎莎[1,2] 陈冬梅[1,2] 罗春雷[1,2] 曾彩虹[1,2] 陈惠萍[1,2] 刘志红[1,2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院 全军肾脏病研究所,南京210002

出　　处：《中国实用内科杂志》2013年第10期800-804,共5页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察抗肾小球基底膜（GBM）肾炎患者的临床和病理特征。方法收集2000--2010年在南京军区南京总医院全军肾脏病研究所住院并行肾活检诊断为抗GBM肾炎患者38例，根据入院时的血清肌酐浓度（Scr）分为2组：Scr〈530μmol／L为A组（16例）；Scri〉530μmol／L为B组（22例）。比较两组患者临床、实验室检查和肾活检病理特征。结果38例患者中，男21例，女17例；平均年龄（44．3±18．2）岁；从发病到确诊时间平均为7．43周，确诊时已有半数以上（57．9％）的患者Scr≥530μmol／L，表现为急进性肾炎综合征26例患者（68．4％），急进性肾炎合并大量蛋白尿低蛋白血症者12例（31．6％），肉眼血尿高达65．8％。月体发生率为40％～100％，≥85％占34．2％。与A组相比较，B组患者年龄较大，病程较长，临床表现为少尿无尿者较多见，Scr明显升高；肾间质损伤的实验室指标差异具有统计学意义；而A组患者尿蛋白定量较多、血尿程度相对较重，但差异无统计学意义。病理上B组患者包囊壁断裂、小管炎、炎症细胞浸润均明显高于A组，新月体形成百分比差异则无统计学意义。结论本组患者肉眼血尿发生率高，诊断时多数表现为尿毒症，全部患者新月体形成≥40％。确诊时Scr水平、病程中是否出现少尿、无尿及肾间质损伤的实验室指标可预测肾脏损伤程度。Objective To investigate the clinical and pathological features of patients with anti-glomerular basement mem- brane nephritis. Methods Thirty-eight patients hospitalized in Institute of Nephrology, Jinling Hospita from 2001 to 2010 who were diagnosed as anti-GBM nephritis by renal biopsy were enrolled and divided into two groups according to levels of serum creatinine （Scr） ： Set ≥ 530 μmol/L as group B （ n = 22 ） , Scr 〈 530 p, moL/L as group A （ n = 16 ）. Clinical, laboratory tests and renal biopsy and pathological features were compared between the two groups. Results There were 21 males and 17 females with average age of（44. 3 ±18, 2） years. The average time from onset to diagnosis was 7.43 weeks. More than half（ 57.9% ）of the patients had Scr 〉 530 μmol/L when diagnosed. Twenty-six （68.4%）of the patients had manifestations of rapidly progressive glomerulonephfitis syndrome. Twelve （ 31.6% ） of the patients had manifestations of rapidly progressive glomerulonephritis accompanied with massive proteinuria and hypoproteinemia. We found 65.8% of the patients had gross hematuria. Crescents were observed in 40% - 100% of patients in pathology,while 34. 2% of the patients had more than 85 % of crescents. Compared with group A, the group B was older in age and had significantly longer course and higher Ser. Clinical manifestations of oliguria anuria was more common in group A;laboratory indicators of renal interstitial injury also had statistically significant differences between the two groups. The patients in group A had more severe urinary protein ex- cretion and hematuria, but without statistical significance. The uremic group package wall fracture, tube inflammation, in- flammatory cell infiltration were significantly heavier than the group A, but crescent formation had no significant difference. Conclusion High incidences of gross hematuria were observed in this group of patients. The majority had the performance of uremia when diagnosed. All patients had≥40% of crescen

关 键 词：抗肾小球基底膜肾炎 病理 肌酐 

分 类 号：R692.3[医药卫生—泌尿科学]