膜性肾病合并新月体形成的临床和病理特点研究  

Clinicopathological characters of membranous nephropathy companied with crescents formation

作　　者：张宇 刘东伟 潘少康 刘章锁 ZHANG Yu;LIU Dong-wei;PAN Shao-kang;LIU Zhang-suo(Department of Integrated Traditional and Western Nephrology,The First Affiliated Hospital of Zhengzhou University,Research Institute of Nephrology of Zhengzhou University,Henan Provincial Research Center for Kidney Disease,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院中西医结合肾病科,郑州大学肾脏病研究所,河南省肾脏病研究中心,河南省慢性肾脏病精准诊疗重点实验室,郑州450052

出　　处：《医药论坛杂志》2022年第7期1-6,共6页Journal of Medical Forum

基　　金：国家自然科学基金(U1904146)。

摘　　要：目的 探讨膜性肾病合并新月体形成的临床病理特点。方法 回顾性研究郑州大学第一附属医院2015年1月-2019年12月间的肾活检病例4 396例,对17例特发性膜性肾病合并新月体的临床病理特点进行分析。结果 该队列包括9例男性和8例女性,平均年龄为54.0(24~74)岁。临床表现包括大量蛋白尿(平均24 h尿蛋白5.9 g/d)、镜下血尿和肾功能不全(平均血清肌酐397.8μmol/L)。病理特征表现为新月体平均累及69%的肾小球,大多数病例出现Ⅰ期或Ⅱ期膜性改变。对16例患者进行了随访,所有患者均接受了类固醇或环磷酰胺治疗,在平均15.3个月的随访中,9例患者的肾功能稳定或改善,而7例患者的肾功能恶化并进展为终末期肾病,随访期间有2例患者死亡。结论 伴有新月体的膜性肾病相对罕见,同时伴有重度蛋白尿、镜下血尿和肾功能不全,预后多变,本研究7例患者进展到终末期肾病或死亡,这表明或许应按照快速进展性肾小球肾炎加以治疗。Objective To investigate the clinicopathological features of membranous nephropathy complicated with crescents formation.Methods A retrospective study was performed on 4396 renal biopsy cases in the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019,and the clinicopathological characteristics of 17 cases of idiopathic membranous nephropathy complicated with crescent were analyzed.Results The cohort included 9 men and 8 women with a mean age of 54.0(24-74) years.Clinical manifestations included massive proteinuria(mean 24-hour urine protein 5.9 g/d),microscopic hematuria and renal insufficiency(mean serum creatinine 397.8 μmol/L).Pathological features showed crescents involving an average of 69% of the glomeruli, and most cases showed stage I or stage II membranous changes.Sixteen patients were followed, all receiving steroids or cyclophosphamide, and at a mean followed-up of 15.3 months, renal function was stable or improved in 9 patients, while renal function deteriorated in 7 patients and progressed to end-stage renal disease, and 2 patients died during follow-up.Conclusion Membranous nephropathy with crescents is relatively rare, with severe proteinuria, microscopic hematuria, and renal insufficiency.The prognosis is variable, with 7 patients progressing to end-stage renal disease or death suggesting that rapid progressive glomerulonephritis is treated.

关 键 词：膜性肾病 新月体 自身抗体 临床病理特征 

分 类 号：R692[医药卫生—泌尿科学]