IgA肾病伴恶性高血压患者微血管病变意义初探  

Impact of microvascular injury on IgA nephropathy associated with malignant hypertension： a preliminary study

作　　者：施潇潇[1] 夏鹏[1] 文煜冰[1] 蒋兰萍[1] 李航[1] 李雪梅[1] 李学旺[1] 陈丽萌[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730

出　　处：《中华肾脏病杂志》2013年第8期605-610,共6页Chinese Journal of Nephrology

基　　金：国家重点基础研究发展计划（973计划）项目（2012CB517803）;国家自然科学基金（30971369,81170674,81170665）

摘　　要：目的观察IgA肾病伴恶性高血压（IgAN—MHT）患者的临床病理特点，评价肾脏小动脉和微动脉病变，探讨肾小管周毛细血管（PTC）缺失和肾小管间质巨噬细胞浸润与临床表现的相关性。方法2003年1月至2012年3月在北京协和医院经肾活检确诊的1765例原发性IgA肾病患者，共34例（1．9％）临床病理确诊为IgAN-MHT，收集临床资料，半定量分析肾小球、肾小管、肾间质及肾血管病变，免疫组化染色方法评价PTC（CD34^＋）缺失、肾小管间质巨噬细胞（CD68^＋）浸润情况。及其与临床指标的相关性。结果IgAN—MHT多见于青年男性，除血压显著升高外，表现为不同程度的肾功能损害和蛋白尿；小动脉和微动脉均有不同程度的急、慢性病变共存现象，但二者与肾功能没有显著相关性；肾间质有显著巨噬细胞浸润，与肾功能显著相关，PTC缺失表现亦突出，PTC面积比例与肾功能呈良好的相关性。结论IgAN—MHT患者肾脏微动脉和小动脉病变与。肾功能相关性差，肾小管间质巨噬细胞浸润和PTC缺失表现突出并与肾功能损害相关。Objective To observe the vascular lesions of renal small arteries and arterioles as well as clinco- pathological characteristics among patients with IgA nephropathy associated with malignant hypertension （IgAN-MHT）. To explore the clinical significance of peritubular capillary （PTC） loss and renal tubulointerstitial macrophage infiltration in the same population. Methods Thirty- four （1.9%） IgAN-MHT patients were diagnosed among the 1765 cases of primary IgA nephropathy in Peking Union Medical College Hospital from January 2003 to March 2012. Their clinical records were reviewed and the lesions of glomeruli, tubules, interstitium and renal vessels were semi-quantitatively re -evaluated. PTC and renal tubulointerstitial macrophages were demonstrated by immunohistochemical staining. Results The IgAN-MHT patients were mainly young males with very high blood pressure. They had variant renal function impairment and urinary protein excretion. Acute and chronic vascular changes coexisted in the renal small arteries and arterioles, but all the vascular lesions failed to correlate with renal function. The renal tubulointerstitial macrophage infiltration was prominent and correlated well with renal function. PTC loss was also prominent and the PTC proportion was correlated with renal function. Conclusions In IgAN- MHT patients, the renal vascular changes do not correlate with renal function, but PTC loss and renal tubulointerstitial macrophage infiltration are both prominent and may reflect renal function impairment.

关 键 词：高血压 恶性 肾小球肾炎 IgA 巨噬细胞 肾小管周毛细血管 

分 类 号：R692.3[医药卫生—泌尿科学] R544.1[医药卫生—外科学]