肾小管间质病变在成人PNS患者中的病理与临床特点  

The clinical and pathological significance of tubulointersitial lesions in primary nephrotic syndrome.

作　　者：李培睿[1] 王铁萍[1] 杨彦强[2] 

机构地区：[1]攀枝花钢铁(集团)公司职工总医院,四川攀枝花617023 [2]广州中山医科大学附属第一医院,广东广州510080

出　　处：《四川医学》2002年第7期722-724,共3页Sichuan Medical Journal

摘　　要：目的　分析成人原发性肾病综合征 (PNS)患者肾活检中不同程度肾小管间质病变与临床的关系 ,指导临床治疗。方法　回顾性分析 96例成人 PNS的临床与病理 ,按肾小管间质病变程度分为轻度、中度、重度三组 ,比较三组的高血压、血红蛋白、血尿、血肌酐、肾小球病变程度及激素的疗效 ,并观察重度病变组的病理特点。结果　重度病变组其高血压、贫血、血肌酐升高的发生率较高 ,激素疗效差 ,与轻度病变组比较有显著性差异 (P<0 .0 5 ) ;血尿较常见 ,仅少数患者对激素联合 CTX等免疫抑制剂有效 ;重度病变组均伴有明显的肾小球硬化 ,部分还有血管病变 ,病理类型以弥漫性重度系膜增生性肾小球肾炎、膜性肾病 ～ 期、Ig A肾病 型、局灶节段性肾小球硬化居多。结论　对有重度肾小管间质病变的 PNS患者应正规应用激素和 /或免疫抑制剂减少尿蛋白 ,积极控制血压 ,保护肾功能 ;而对激素联合免疫抑制剂疗效差的 ,应以保护肾功能为主 ,不可过分强调激素及免疫抑制剂的应用 。Objective To analyse the clinical significance of anisodegree renal tubulointersitial lesions in patients with primary nephrotic syndrome.Methods 96 patients with primary nephrotic syndrome were divided into mild,moderate and serious groups according to levels of tubulointersitial lesions,and clinical data,such as hypertension,haemoglobin,hematuria,serum creatinine levels,glomerule lesions and the effect of prednisone treatment were analysed restropectively.Results ①In serious group,the incidences of hypertension,anemia,increased serum creatinine levels were significantly higher than that in mild group ( P <0.05).Hematuria was common and the effect of prednisone and CTX treatment was poor;②The major pathology types of serious groups were diffuse mesangioproliferative glomerulonephritis,membranous nephropathy Ⅱ～Ⅲ,IgA nephropathy Ⅳ,focal segmental glomerulosclersis,and glomerulosclerosis and angiopathy were also common.Conclusion Patients with heavy tubulointersitial lesions should receive regular prednisone and/or immunosuppressive drugs and have their blood pressure controlled,but to those patients who responsed poorly to prednisone and immunosuppressive treatment,other drugs can be used to lower urine protein.

关 键 词：原发性肾病综合征 肾小管间质病变 肾脏病理 

分 类 号：R692.02[医药卫生—泌尿科学]