妊娠高血压综合征型肾病综合征的临床特征和病理改变

Clinical characteristics and pathological changes of nephrotic syndrome with pregnancy induced hypertension

目的：观察妊高征肾病型的临床特点及病理变化,探讨其可能的机制。方法：对本科行肾活检的妊高征肾病型(肾病组)与同期本院非肾病型妊高征患者(对照组)的实验室检查及病理进行分析。结果：肾病组血浆白蛋白低于、24h尿蛋白定量高于对照组,差异非常显著(均P＜0.01)；血浆尿素氮、肌酐、尿酸水平均明显高于对照组(均P＜0.05)；肾功能损害发生率亦明显升高(P＜0.01)；妊高征肾病型肾脏光镜改变为肾小球毛细血管内皮细胞病,部分病例免疫荧光示肾小球毛细血管壁有IgM、IgG和纤维蛋白原的沉积。结论：妊高征型肾病综合征肾脏损害重,病理改变典型,产后择时行肾活检对明确诊断、指导治疗颇有意义。

Objective： To observe the clinical and pathological features of nephrotic syndrome with pregnancy induced hypertension （NSP） and explore its possible mechanism. Methods： The blood and urine tests results and renal histopathology were observed and patients with NSP （NSP group） who have been undergone renal biopsy and patients with pregnancy induced hypertension （control group）, at the same time, were analyzed. Results： Plasma albumin in NSP group was significantly lower than, and proteinuria in 24 hours very higher than those in control group （all of P〈0.01）, blood uria nitrogen, creatinine and uric acid in NSP group were higher than that in control group （all of P〈 0.05）, the renal insufficiency rate was also marked higher than that in control group （P〈0.01）. The pathological change of kidney under light microscopy in NSP is glomerular capillary endotheliosis. IgM, IgG and fibrinogen were found in glomerular capillary Immunofluorescence in certain NSP. Conclusion：The renal insufficiency of NSP is more serious, and its pathological changes are typical. Postpartum renal biopsy is beneficial to diagnosis and treatment.