先兆子痫肾病患者的临床病理及转归

Clinical and pathological features in patients with preeclamptic nephropathy

目的:总结19例先兆子痫肾病患者的临床特点、肾活检病理改变特征及转归。方法:19例先兆子痫肾病患者,15例为初产妇,4例为经产妇,平均年龄23～40(28.1±4.5)岁。观察指标包括病程、临床表现、肾功能、尿液检查、肾活检病理、临床与病理联系及临床转归。结果:临床表现为高血压(100%)、蛋白尿(100%),少部分患者伴有镜下血尿(15.8%)和肾功能不全(21.1%)。肾活检组织改变表现为肾小球内皮细胞增生、肿胀(94.7%),系膜细胞增多、系膜基质增加(89.5%),周边袢弥漫或节段双轨(78.9%),肾小球局灶节段硬化(31.6%)。内皮细胞增生指数与终止妊娠时间有关,随着终止妊娠时间的延长,内皮细胞增生、肿胀逐渐消退(P<0.05)。小管间质损害较轻,但是,病理表现为局灶节段性肾小球硬化(FSGS)样损害的患者,小管间质损害较重。血管病变主要表现为小动脉透明变性(36.8%)、内皮肿胀(26.3%)、内膜增厚(26.3%)、弹力层增厚分层(26.3%),严重患者血管壁呈纤维素样坏死(5.3%)。终止妊娠后绝大部分患者,血压下降,尿蛋白减少至转阴,但病理表现FSGS、血管病变较重者尿检异常持续存在。结论:先兆子痫肾病患者临床主要表现为高血压、蛋白尿,部分患者出现镜下血尿,血肌酐升高。肾脏病理特征性表现以内皮细胞病变为主,其他表现包括系膜细胞增多、

Objective: To investigate the clinical and pathological features in patients with preeclamp tic nephropathy. Methodology:From May, 1993 to March, 2004, nineteen patients with preeclamptic nephropathy, proved by renal biopsy, were studied retrospectively. Fifteen of the women were nulliparous, four of the women were multipara, mean age was (28.1±4.50) years old (range from 23 to 40). The time of symptom appearing, onset symptoms, labor atory examinations and renal histology were analyzed. Results:Their main clinical manifestations were severe hypertension(100%), and various degree of proteinuria (100%). Pathological features of these patients were endo thelial hyperplasia and swelling (94.7%), various degree of increasing in me sangial cell and matrix(89.5%), formation of the double contours(78.9%), f ocal and segmental glomerulosclerosis (31.6%). There was a relation of endothel ial proliferation and the different time of renal biopsy after termination of pr egnancy, and with the time prolonging the proliferation of endothelium became de crease (P<0.05). The patients with preeclamptic nephropathy disclosed mild tubulo-instersitial lesion, while in the patients with severe tissue lesions su ch as focal segmental glomeruloscloerosis, more severe tubulo-interstitial lesio n was observed. Vascular changes as hyaline degeneration of arteriole, swollen e ndothelium of arteriole and hyperplasia of artery intima were found in 36.8%, 2 6.3% and 26.3% respectively. Severe necrosis of arteriole was observed in 5.26% accompanied by severe clinical course. After delivery, edema disappeared, hyper tension improved and proteinuria ameliorated gradually in most of patients, howe ver, proteinuria was last in some patients with focal and segmental glomeruloscl erosis or severe lesion of arteriole. Conclusion:The main clinical manifestations in patients with preeclamptic nephropathy were hypertension, and proteinuria. The endothelial hyperplasia and swelling was a sp ecific histological feature, and in addition, increasing in mesangial cells and mesangial matrix, formation of the double contouring, thickening of the bowman's capsule, and focal and segmental glomerulosclerosis was often found in preeclam ptic nephropathy. Prognosis was good, however, in the patients with focal and se gmental glomerulosclerosis or severe lesion of arteriole was not so well.