肉芽肿样间质肾炎患者的临床特点及预后分析  

Clinical features and prognosis of patients associated with ganulomatous interstitial nephritis

作　　者：王蔚[1] 邹玉蓉[1] 李贵森[1] 张萍[1] 汪伟[1] 王莉 

机构地区：[1]成都,四川省医学科学院四川省人民医院肾内科610072

出　　处：《临床肾脏病杂志》2014年第6期327-331,共5页Journal Of Clinical Nephrology

基　　金：四川省卫生厅基金项目（Nn110119）.

摘　　要：目的肾间质呈肉芽肿样改变是少见的病理表现，既往报道的病因多为结节病、药物、感染、结核导致的肾间质肉芽肿样改变。本研究拟了解肾间质呈肉芽肿样改变的病因、临床特点及预后。方法回顾性分析四川省人民医院肾内科2006年7月至2013年6月共2330例肾活检患者资料，其中肾活检组织肾小球数目大于10个的患者纳入分析。免疫组织化学染色方法标记CD3T淋巴细胞、CD20B淋巴细胞、CD68单核巨噬细胞在肾间质的表达。结果表现为肉芽肿样间质肾炎的8例患者占肾活检的0．34％（8／2330），其中男女各半，发病年龄26~51岁。病因包括系统性红斑狼疮（systemic lupus erythematosus，SLE）、狼疮肾炎（1upus nephritis，LN）、IgA肾病（IgA nephropathy，IgAN）、抗中性粒细胞胞浆抗体（anti-neutrophil cytoplasmic antibody，ANCA）相关性血管炎和结核性肉芽肿、原发性肾病综合征。8例患者均表现为蛋白尿、血尿。24h尿蛋白定量0．153～6．90g／24h；其中有5例患者合并高血压。4例患者合并肾衰竭。间质浸润的炎症细胞以CD3T淋巴细胞为主。随访时间6～64个月，2例SLE合并LN患者死亡，1例患者死亡原因为肺出血，另1例为肺部感染。1例ANCA相关性血管炎进入终末期肾脏疾病。结论肾间质呈肉芽肿样改变是罕见的病理表现。本中心资料显示最常见病因可能是免疫相关疾病，其临床症状重，合并症多，预后极差。Objective Granulomatous interstitial nephritis（GIN） is a rare histologic diagnosis. Previous reported that GIN has been associated with medication, infections, sarcoidosis, tuberculosis and so on. GIN＇s etiology, clinical manifestations and prognosis in Chinese population are unclear. The purpose of this study was to analyze clinical features and outcome of patients who had GIN treated in Nephrology Department of Sichuan Provincial People＇s Hospital. Methods We retrospectively analyzed the kidney biopsies data of 2 330 patients treated in Nephrology Department of Sichuan Provincial People＇s Hospital, between June 2006 and July 2013. GIN was defined as interstitial nephritis in which the inflammatory infiltrate included lymphocytes or monocytes/macrophages aggregates with Light mi- croscopy description. Immunohistochemical method was applied to observe the inflammatory infiltration of CD3 T lymphocytes. CD 2013 lymphocytes and CD68 monocytes/macrophages in renal biopsy specimens of GIN. GIN patients clinical data were investigated in this study. Results We identified 8 GIN cases of 2 330 patients（0. 34%） in Sichuan Provincial People＇s Hospital. Male：female was 1 ： 1, Age：26～51 years old. T lymphocytes were the major infiltrating cells in renal biopsy specimens. GIN has been associated with SLE, LN, IgAN, ANCA associated vasculitis, and Tuberculosis and Primary ne- phritic syndrome. All patients presented with proteinuria and hematuria. 24-hour urinary protein： 0. 153～6. 90 g/24 h. 5 patients presented with hypertension and 4 patients presented with renal fail-ure. CD3T lymphocytes were the major infiltrating cells in renal biopsy specimens. After follow up of 6～64 months, there were 2 SLE LN patients death in the group. One died from pulmonary hemorrhage 10 days after diagnosis and another patient died from pneumonia 15 month after diagnosis. One ANCA associated vasculitis patients required renal replacement therapy after 64 months follow up. Conclusions Granulomatous interstitial nep

关 键 词：肉芽肿 间质肾炎 预后 

分 类 号：R520.3[医药卫生—内科学]