肾小球疾病患者肾间质泡沫细胞的分布及其临床意义

Significance of renal interstitial foam cells in patients with glomerular diseases

目的:观察肾小球疾病患者肾间质泡沫细胞的分布特点,分析其与临床表现及肾组织病理改变之间的联系。方法:选取经临床病理明确诊断的Alport综合征(AS)125例,特发性膜性肾病(IMN)192例,IgA肾病(IgAN)388例,局灶节段性肾小球硬化(FSGS)137例。观察肾组织泡沫细胞的分布,并对肾间质有无泡沫细胞患者的临床和病理进行比较。结果:(1)AS、IMN、IgAN、FSGS四种疾病肾组织中均存在肾间质泡沫细胞,发生率分别为64.8%、21.4%、12.4%、36.5%,其中以AS中最为多见。(2)肾间质泡沫细胞组肾小球节段硬化的发生率及硬化比例均显著高于无泡沫细胞的对照组,AS、IgAN患者泡沫细胞组间质纤维化程度重于对照组。(3)AS、IgAN患者肾间质泡沫细胞组尿蛋白、血脂水平显著高于对照组(P<0.01)。FSGS患者肾间质泡沫细胞组三酰甘油水平显著高于对照组,但两组间尿蛋白水平未见差异。结论:肾间质泡沫细胞在AS、IMN、IgAN、FSGS患者中均可以发现,但以AS患者最多见。肾间质泡沫细胞的形成与尿蛋白、血脂的水平有关。肾间质泡沫细胞的存在可能与肾组织慢性化病变形成有关。

Objective：To evaluate the significance of renal interstitial foam cells in patients with different glomerular diseases, and to determine the relationship between the renal interstitial foam cells and the degree of proteinuria and hyperlipidemia as well as the progression of these diseases. Methodology： The patients with Alport syndrome （ AS n = 125 ） , idiopathic membrane nephrology （ IMN n = 192 ） , IgA nephropathy （ IgAN n = 388 ） and focal segmental glomerulosclerosis （FSGS n=137） were enrolled in this study. According to with or without foam cells in renal interstitum, those patients were divided into two groups ： group Ⅰ （ FC ＋ group） with foam cells ; and group Ⅱ（ FC - group） without foam cells. Results： 1. The foam cells were observed in all of the glomerular diseases. The frequence of interstitial foam cells was 64. 8% in AS, 21.4% in IMN, 12. 4% in IgAN, and 36. 5% in FSGS respectively, however, it was most common in AS. 2. It was found that the segmental glomerular sclerosis was significantly higher in FC ＋ group than that in FC - group. The interstitial fibrosis were more severe in FC ＋ group of patients with AS and IgAN. The level of proteinuria and serum lipids were also significantly higher in FC ＋ group of patients with AS and IgAN （ P 〈 0.01 ）. There was no difference of proteinuria between the two groups in patients with FSGS, although the level of triglyceride was significantly higher in FC ＋ group than that in FC - group. Conclusion：The renal interstitial foam cells caught be observed in patients with AS, IMN, IgAN, FSGS, but it was most common in patients with AS. There might be a relationship between the degree of proteinuria, hyperlipidemia and formation of foam cells in the renal interstitial in patients with glomerular diseases. The present of foam cells in the renal interstitial may contribute to the progression of these diseases.