轻链近端肾小管病超微病理特征及免疫电镜的诊断价值  

Ultrastructural pathology features and diagnostic value of immunoelectron microscopy in light chain proximal tubulopathy

作　　者：侯晓涛 陈建雄 钟学军[3] 岳书玲[3] 王伶 杨惠霏 官阳[5] 周军[1,2] Xiaotao Hou;Jianxiong Che;Xuejun Zhong;Shuling Yue;Ling Wang;Huifei Yang;Yang Guan;Jun Zho(Department of Pathology,Southern Medical University School of Basic Medical Sciences,Guangzhou 510515,Guangdong Province;Department of Pathology,Nanfang Hospital of Southern Medical University,Guangzhou 510515,Guangdong Province;Guangzhou Kingmed Diagnostics Center,Guangzhou 510005,Guangdong Province;Fuda Cancer Hospital Affiliated to Jinan University,Guangzhou 510063,Guangdong Province;Ultrastructural Pathology Center,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei Province,China)

机构地区：[1]南方医科大学基础医学院病理学系,广州510515 [2]南方医科大学南方医院病理科,广州510515 [3]广州金域医学检验中心,广州510005 [4]暨南大学附属复大肿瘤医院,广州510063 [5]武汉大学人民医院超微病理中心,武汉430060

出　　处：《中华肾病研究电子杂志》2023年第2期67-73,共7页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

摘　　要：目的探讨轻链近端肾小管病(LCPT)的超微病理学特征及免疫电镜的诊断价值。方法选择本中心2018至2021年确诊或考虑轻链近端肾小管病病例140例,所有病例均进行免疫电镜检查,分析其超微病理特点,并探讨免疫电镜在轻链近端肾小管病诊断中的作用。结果病例以中老年为主,男性患者明显多于女性,所有病例均存在一定蛋白尿。这些LCPT患者的超微结构可分结晶型及非结晶型两大类,共5个形态学变异体。免疫病理分析,Kappa型轻链稍多,结晶型LCPT中,Kappa型占绝对优势,高达87.80%。免疫电镜在4种免疫病理检查方法中检出率最高,达94.29%。结论LCPT具有独特的超微病理表现,电镜及免疫电镜在LCPT诊断、分型及鉴别诊断上具有关键的作用,尤其在早期结晶型LCPT中。Objective To investigate the ultrastructural pathology features and the diagnostic value of immunoelectron microscopy in light chain proximal tubulopathy(LCPT).Methods A total of 140 cases of LCPT confirmed or considered in our center from 2018 to 2021 were selected.All cases were examined by immunoelectron microscopy to analyze their ultrapathological characteristics and explore the role of immunoelectron microscopy in the diagnosis of LCPT.Results The patients were mainly middle-aged and elderly with the male patients being significantly more than the female.All the patients had proteinuria.The ultrastructure of these LCPT patients could be divided into crystalline and non-crystalline types,with a total of 5 morphological variants.Immunopathology analysis showed that kappa light chain was slightly more,and even predominated in crystalline LCPT(87.80%).The detection rate of immunoelectron microscopy was the highest among the four immunopathological examination methods(94.29%).Conclusion LCPT had unique ultrastructural pathology features.Electron microscopy and immunoelectron microscope may play an important role in the diagnosis、classification,and differential diagnosis of LCPT,especially of early crystalline LCPT.

关 键 词：免疫电镜 轻链 近端小管病 超微病理 

分 类 号：R692.6[医药卫生—泌尿科学]