汞中毒性肾病综合征临床病理分析  

Clinicopathological analysis on mercury poisoning-associated nephritic syndrome

作　　者：赵凤玲 陈新 郭伟 李洁雅 余善法 

机构地区：[1]河南省职业病防治研究院,河南郑州450052

出　　处：《中国职业医学》2016年第3期281-284,共4页China Occupational Medicine

基　　金：国家科技支撑计划项目(2014BAI12B01);国家临床重点专科建设项目(2011-17)

摘　　要：目的探讨汞中毒性肾病综合征的临床病理特点及治疗方法。方法分析9例确诊为汞中毒性肾病综合征患者的临床及病理资料。结果 9例患者中汞冶炼工2例,仪表生产工1例,中药配制人员1例,使用中药偏方治疗牛皮癣者4例,使用增白祛斑化妆品者1例。9例患者临床表现均符合肾病综合征,表现为大量蛋白尿、低蛋白血症、水肿及高脂血症。驱汞治疗前一次性尿汞水平为0.09～0.75 mg/L。肾组织活检病理检查结果显示：微小病变性肾病4例,Ⅰ期膜性肾病5例。经驱汞和糖皮质激素治疗,9例患者肾病综合征均治愈。结论汞中毒性肾病综合征肾组织病理学改变主要表现为微小病变肾病和膜性肾病。糖皮质激素联合驱汞治疗可获得临床完全缓解。Objective To explore the clinicopathological characteristics and therapeutic approach for mercury poisoningassociated nephritic syndrome. Methods Clinical and pathological data of 9 patients diagnosed with mercury poisoningassociated nephritic syndrome were analyzed. Results Among the 9 cases,2 cases were mercury smelters,1 case was instrument production worker,1 case was traditional Chinese medicine preparation worker,4 cases were psoriasis treated by folk prescription of traditional Chinese medicine,and 1 case used cosmetics for whitening and freckle removal. All cases showed clinical manifestation of nephritic syndrome that included large amount of proteinuria,hypoalbuminemia,edema and hyperlipidemia. The concentrations of urine mercury in the patients were from 0. 09 to 0. 75 mg / L before treatment.Pathology examination on renal biopsy showed that there were 4 cases of minimal change nephropathy and 5 cases of membranous nephropathy at stage Ⅰ. The patients with nephritic syndrome were cured after mercury driving and treatment with corticosteroid. Conclusion The kidney histopathology changes in patients with mercury poisoning-associated nephritic syndrome are primarily characterized by minimal change and membranous nephropathy. The mercury driving combined treatment with corticosteroid can completely relieve the clinical symptoms of the patients with mercury poisoningassociated nephritic syndrome.

关 键 词：汞中毒 肾病综合征 病理 微小病变性肾病 膜性肾病 

分 类 号：R135.13[医药卫生—劳动卫生]