新月体肾炎20例临床和病理分析

Analysis of clinicopathological features in 20 patients with crescentic glomerulonephritis

目的分析新月体肾炎的临床表现、病理类型及其预后,以提高对本病的认识。方法2000年~2005年我院住院并经肾活检证实的新月体肾炎患者20例,我们对其临床、实验室检查、病理及随访资料进行回顾性分析。结果20例新月体肾炎患者,临床主要表现为蛋白尿、血尿、肾功能急剧减退、贫血、双肾大小正常或偏大。病理检查其新月体形成率为（82.83%±15.51%）,袢坏死发生率为60%,球性硬化发生率为50%。其中3例为抗肾小球基底膜型（Ⅰ型）,9例为免疫复合物型（Ⅱ型）,8例为寡免疫复合物型（Ⅲ型）。20例患者均给予甲基强的松龙针（MP）加环磷酰胺（CTX）冲击或甲基强的松龙针加骁息治疗,10例（50%）未愈,7例（35%）好转（血肌酐有下降,但未正常）,3例（15%）治愈（随访1~2年,血肌酐正常）。结论新月体肾炎临床表现及肾脏病理均损害严重,如能给予积极有效治疗,有50%的患者可避免透析治疗。

Objective [ To improve the cognition on CGN,the present study analysed the clinical, pathological characteristics and prognosis of crescentic golmenalonephritis （CGN）. ] To analyse the chnicopathological characteristics and prognosis of cresentic glomenalonephritis （CGN） and to improve the recognition of the latter. Methods Twenty CGN patients diagnosed with thepathological examination were retrospectively analysed from 2000 to 2005 in hospital. Results Proteinuria,hematuria （severe and moderate） ,renal dysfunction and anaemia, normal or enlargement of the both kidneys were the most common clinical presentation. Pathologically, segmental crescents （ 82. 83 ± 15.51% ）, capillary necrosis （ 60% ） and global sclerosis（50% ） were high in CGN. The pathological findings included counterplea glomeruliBowman＇ s membrane （ Ⅰ）, immunity composite （Ⅱ） and few immunity composite （Ⅲ）. 20 patients received Mp, CTX or MP, MMF treatment. 50% of these patients were not healedwhereas the renal function could recover in 15% of them and could improve in 35% of them. Conclusion Clinically and pathologically, all were severely injured in crescentic glomenalonephritis. 50% of these patients could avoid hemodialvsis if received early effective treatment.