中药木通肾脏损害的临床和病理特征  

Clinical and pathological features in patients with renal injury associated with Aristolochia manshuriensis Kom

作　　者：胡伟新[1] 刘志红[1] 程震[1] 曾彩虹[1] 陈惠萍[1] 黎磊石[1] 

机构地区：[1]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2003年第6期504-511,共8页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:总结20例木通中毒病例肾脏损害的临床特点和肾活检病理改变特征。 方法:20例木通肾损害患者,男性17例,女性7例,年龄22~68岁。其中服药前有肾炎3例,尿路结石5 例。13例服木通汤药[(汤药组,再分为大剂量组(≥10g/d,n=9)和小剂量组(≦6g/d,n=4));7例服用含木通的中成药(成药组)。观察指标包括木通剂量,服药及发病时间、病程、首发症状、肾功能、尿液检查及肾活检病理。 结果:①发病过程及临床表现与木通剂量相关。出现症状时间分别为大剂量组4h(2h^6d)、小剂量组2 mo(2~6 mo)、成药组24 mo(6~36 mo)。大剂量组以消化道症状为首发症状,6例表现为急性肾衰(ARF),3例慢性肾衰(CRF);小剂量组及成药组以乏力、夜尿增多起病,表现为CRF。②患者尿蛋白均<1.5g/d[大剂量ARF组、大剂量CRF组、小剂量组及成药组分别为(1.00.3)、(0.980.2)、 (0.90.3) 、(0.80.2)g/d],无高尿酸血症,血尿及高血压发生率低。③大剂量ARF组50%为少尿型,糖尿(100%)及氨基酸尿(75%)阳性率高。肾活检表现为急性肾小管坏死,肾小管基膜(TBM)裸露现象普遍。5例转为CRF,重复肾活检显示小管间质出现慢性化病变。大剂量CRF组起病方式、尿液检查尤其糖尿(100%)及氨基酸尿(66.7%)阳性率与ARF患者比较无统计学差异,但病程显著延长(P<0.05)。Objective: To retrospectively investigate the clinical and renal histological characteristics in twenty patients with renal injury associated with Aristolochia manshuriensis Kom (Mutong, MT). Methodology: Twenty patients who had taken MT (13 in mixed MT decoction, and 7 in patent drugs) with renal manifestations were collected in this study. They were 13 males and 7 females, age ranged from 22 to 68 years old. Eight patients had underlying kidney diseases prior to MT treatmment (kidney stone in 5 patients, primary mesangial proliferative glomerulonephritis in 3 patients). They were divided into 3 groups according to the MT dose and drug type: group A (MT >10g/d in decoction, n=9), group B (MT <6g/d in decoction, n=4) and group C (MT patent drug, n=7). The duration of MT administration, symptom appearing time, onset symptoms, laboratory examinations and renal histology were analysed. Results: ①Eight of 9 patients in group A developed severe gastrointestinal symptoms at the 1st to 5th day after the initial MT treatment, six of them presented with ARF (group A-ARF), 3 of them with CRF (group A-CRF). All of group B and group C patients had onset symptoms with fatigue and nocturia at the 2nd-6th (median 2) and 6-36th months (median 24) respectively after initial MT treatment. ②All patients except 3 with underlying renal disease were found to have low urinary protein excretion [(1.00.3),(0.980.2),(0.90.3),(0.80.2)g/d in group A-ARF, group A-CRF, group B and group C], low rate of hematuria and hypertension, and absence of hyperuricemia. ③Patients in group A-ARF (50% of them were oliguria) showed high yield rate of glucosuria (100%), aminoaciduria (75%), and high level of NAG [(62.026.3)U/gcr] and RBP [(52.924.4)mg/L]. Renal biopsy showed acute tubular necrosis with prominent naked tubular basement membrane (TBM). Five of them progressed to CRF. Repeat renal biopsy at third months after the 1st biopsy showed chronic tubular interstitial lesions without tubular cell regeneration. Three patients in group A-CRF also

关 键 词：木通 肾脏损害 病理特征 临床特点 肾活检 间质纤维化 间质血管狭窄性病变 

分 类 号：R692.9[医药卫生—泌尿科学]