肾活检标本351例电镜检查病理诊断分析

Evaluation of electron microscopy in pathological diagnosis of 351 renal biopsies

目的客观评估电镜检查在肾活检病理诊断中的作用。方法对351例肾活检标本先后进行光镜免疫荧光联合检查以及电镜检查,统计最终病理诊断类型的分布,并对电镜检查在肾活检病理诊断中的作用进行分析,比较电镜检查与光镜免疫荧光联合检查对肾活检病理最终诊断的影响。结果①最终诊断为肾小球疾病的占绝大多数(97.7%),以IgA肾病(18.8%)、薄基底膜肾病(8.8%)、肾小球微小病变(8.3%)、膜性肾病(8.3%)、糖尿病肾病(7.1%)多见;②电镜检查对肾活检病理诊断起决定诊断作用的病例占21.9%,起修正补充作用的病例占23.7%,而起验证作用占54.4%;③电镜检查对45.6%的肾活检最终病理诊断提供有价值信息,而光镜免疫荧光联合检查对54.4%的病例可独立诊断(χ2=5.476,P<0.05)。结论进行电镜检查对肾活检标本病理诊断非常必要,应该常规留取标本进行电镜检查。

Objective To evaluate the role of electron microscopy （EM） in pathological diagnosis of renal biopsies. Methods Three hundred and fifty-one renal biopsy specimens obtained from the patients with renal diseases were studied first by light microscopy（LM） plus immunofluorescence（IF） and final by EM. The distribution of the final diagnosis was observed and the role of EM in pathological diagnosis of renal biopsies was evaluated, then the influence on the pathological diagnosis of renal biopsies was compared between LM plus IF and EM. Results ①Most of final diagnosis was glomerular disease （97.7%）. IgA nephropathy was the most frequent diagnosis （18.8%）, followed by thin basement membrane disease （8.8%）, minimal change disease （8.3%）, membranous nephropathy （8.3%）, and diabetic nephropathy（7.1%）. ② EM provided essential diagnosis in 21.9%, and EM provided correcting or supplementary information in 23.7%, then EM supported or confirmed the LM plus IF findings in 54.4%. ③EM provided useful diagnostic information for final diagnosis in 45.6% of renal biopsies. Otherwise the use of LM plus IF alone in pathological diagnosis was 54.4 % （Х^2 = 5. 476, P〈0.05）. Conclusion EM was essential for the renal biopsy of pathology diagnosis. Therefore, renal biopsy specimen should be routinely reserved for EM.