原发性肾病综合征肾小管间质损伤的病理和临床研究

Clinical Study on Tubulointerstitial Damage in Adult-onset Primary Nephrotic Syndrome

【目的】探讨成人原发性肾病综合征（PNS）肾小管间质损伤（TID）的病理特点与临床指标的关系。【方法】对195例PNS患者TID进行分组（0-1分和≥2分组）。比较24 h尿蛋白总量、血肌酐和尿酸,血胆固醇和甘油三酯与TID的关系。【结果】轻微病变和系膜增生患者TID程度较轻,多为0-1分,而局灶节段肾小球硬化和IgA肾病患者TID程度较重,大多为≥2分,肾小球硬化率与TID程度密切相关。TID为0-1分和≥2分两组患者24 h尿蛋白总量、血胆固醇和甘油三酯相比较差异无显著性（P〉0.05）,但后者血肌酐和血尿酸明显高于前者（P〈0.05）。TID与血肌酐和血尿酸显著相关（P〈0.01）,但与尿蛋白总量和血脂无关。【结论】不同肾小球病理类型的PNS患者TID程度具有不均一性,但肾小球硬化率与TID程度有较好的一致性。PNS患者血肌酐和尿酸与TID相关,可作为预测肾小管间质病变的临床指标。

[Objective] To evaluate the relationship between several clinical predictors and pathological characteristics of tubulointerstitial damage （TID） in adult-onset primary nephrotic syndrome. [Methods] One hundred and ninety five adult inpatients who were diagnosed as primary nephrotic syndrome according to clinical data and renal biopsy results were evaluated. The degree of TID was graded by semi-quantitative including less than 2 scores and equal to or more than 2 scores. The relationship between TID and urine protein in 24 h, serum creatinine and uric acid, serum cholesterol and triglyceride were analyzed in this study. [Results]The degree of TID was mild in patients with mesangioproliferative glomerulonephritis and minimal change disease, but severe in patients with focal segmental glomerulonephritis and IgA nephrology. The rate of glomerulosclerosis correlated with the severity of TID. The serum creatinine and uric acid but not serum lipid, or total 24- hour urinary protein of patients with TID equal to or more than 2 scores were obviously higher than those with TID less than 2 scores （ P 〈0.05）. And serum creatinine and uric acid , but not serum lipid, or total 24- hour urinary protein were related with TID （r=0. 183 and r=0. 377, P 〈0. 01, respectively）. [Conclusion] In adult-onset primary nephrotic syndrome patients, the degree of TID in different pathology types of glomeruli is heterogeneous. But the rate of glomerulosclerosis is consistent with that. The urine total protein and blood lipid are not related to the degree of TID. However, serum creatinine and uric acid positively correlate with that, and they might predict the development and progression of proteinuric nephropathy.