慢性马兜铃酸肾病患者的肾脏B超特征及其临床意义

Characteristics of B-ultrasonic renal changes in chronic aristolochic acid nephropathy

目的探讨慢性马兜铃酸肾病(CAAN)患者的肾脏B超特征及其对判断肾脏病变慢性化程度的意义。方法回顾性分析124例临床确诊为CAAN的患者资料,对其肾脏B超特点以及与肾功能损害之间关系进行分析,并对其中经肾活检确诊的19例CAAN患者与18例非感染性、非AAN的慢性肾小管间质肾病(nAAN-CTIN)患者进行比较。结果CAAN患者的肾脏B超特征主要表现为肾实质厚度变薄(90．3％)、肾脏萎缩(62．9％)和双肾不等大(17．74％);其肾脏长径、体积及实质厚度分别与Scr、eGFR、肾小管功能评分明显相关(P值均<0．05)。19例CAAN与18例nAAN-CTIN患者的比较显示,在两组年龄、性别、病程以及肾功能损害程度无明显差异的情况下,CAAN组肾小管细胞脱落和肾小球缺血皱缩更为严重,而肾间质细胞浸润相对较少(P<0．05)。与nAAN-CTIN组比较,CAAN组患者的肾脏B超体积缩小及实质厚度变薄更为显著(P<0．05),但肾脏B超各项指标与肾脏病理指标的变化未见明显相关性。结论CAAN患者具有肾脏萎缩、肾实质变薄以及双肾不等大的B超特征,与其它原因CTIN的不同特点在于其肾脏萎缩更为显著,尤其以肾脏实质变薄出现较早。CAAN患者肾脏B超检查与肾脏病理变化的相关性尚不肯定,但应可以辅助肾功能损害程度的判断以及CAAN的疾病诊断。

Objective To observe the B- ultrasonic （B-US） renal changes of chronic aristolochic acid nephropathy （CAAN） patients and to determine its value in disease diagnosis. Methods The renal B-US data of 124 CAAN patients were retrospectively studied. The relationship between the B-US characteristics and the renal function was tested. Clinicopathological data of 19 CAAN patients underwent renal biopsy were compared with those of 18 patients with chronic tubulointerstitial nephropathy due to none-aristolochic acid causes （non-AAN-CTIN）. Results The characteristics of renal B-US changes in CAAN patients included diminished parenchyma thickness （90.3%）, atrophy of the kidney（62.90%） and asymmetrically shrinked kidneys （17.74%）. The renal B-US markers, including the longitude, the volume and the parenchyma thickness, were closely associated with the level of Scr, eGFR and the function of renal tubules （P 〈 0.05）. There was no difference in the severity of impairment of renal function between the CAAN-renal biopsy group and the non-AAN-CTIN group. Histological studies showed that the CAAN-renal biopsy group exhibited more severe tubular epithelial exfoliation and glomerular ischemic shrinkage, while the immune cells infiltrating was much less obvious as compared to the non-AAN-CTIN group（P 〈 0.05）. However, the size of the kidney diminished and the parenchyma was thickened more markedly in the CAAN group as compared to those of non-AAN-CTIN （P 〈 0.05）. Conclusions The CAAN patients exhibit the B-US manifestations including kidney shrink, thinning of renal parenchyma and asymmetrically atrophy of the two kidneys, among which the parenchyma thickness was the earliest abnormal index. Compared with the CTIN patients of the other causes, the CAAN patients showed earlier and more significant kidney atrophy. The B-US examination of CKAN patients can be used as an assisted assessing index of clinical impairment of renal function.