肥胖相关性肾病患者流行病学资料及临床病理特征分析

Obesity-related glomerulopathy:A case series of 90 patients

目的：探讨中国肥胖相关性肾病（ORG）患者的临床、病理及流行病学特征。方法：回顾性分析2002年2月至2006年11月在本研究所经肾活检确诊的90例ORG患者的临床、实验室指标和组织形态学特点。并据体重指数（BMI）将研究对象分为三组进行比较：轻度肥胖组（BMI28．0-〈30ks／m^2）、中度肥胖组（BMI30-〈35ks／m^2）和重度肥胖组（BMI≥35ks／m^2）。结果：肾活检的ORG比例为0．89％，并且在研究观察的5年间由0．62％上升至1．0％（P〈0．05）。ORG患者的平均年龄为（37．5±9．26）岁，以18—44岁青年人为主，男性患者占67％。ORG患者BMI31．2ks／m^2，100％为腹型肥胖。其中，轻度肥胖、中度肥胖和重度肥胖的患者分别占49％、37％和14％。ORG患者的平均尿蛋白为（1．48±1．2）g／24h，少量蛋白尿者（0．4—1．0g／24h）占51．1％，大量蛋白尿者（〉3．5g／24h）占10％，表现为典型肾病综合征者仅2例（2．22％）。此外，42．2％患者有肾小球高滤过，6．67％有肾功能减退。除肾脏受累外，ORG患者同时合并多种代谢紊乱，88．1％有胰岛素抵抗，75．0％有脂代谢异常及63．1％有高血压。ORG的组织形态学特征是肾小球体积增大，70％合并局灶节段性肾小球硬化（FSGS），并以“经典型”节段硬化为主。电镜下，足突宽度增加，35．6％出现节段足突的融合。随着BMI的增加，ORG患者的蛋白尿水平（P〈0．05）、肾小球滤过功能（P〈0．05）及足突宽度（P〈0．05）显著增加。结论：中国人群中，ORG的发病率正呈现快速上升趋势；该组患者以青年男性多见，主要表现为轻度、腹型肥胖，少量蛋白尿，代谢紊乱以及肾脏高滤过和FSGS。

Objective：The epidemic of obesity has been paralleled by an increase in the incidence of chronic kidney disease. However, the epidemiological data on obesity-related glomerulopathy （ORG） from developing countries including China, is very limited. Methodology ：10 093 renal biopsies were performed from February 2002 to November 2006 at the Research Institute of Nephrology, Nanjing University School of Medicine, China. ORG is defined as BMI I〉 28.0 kg/m^2 ; urinary protein excretion I〉 0. 4g per 24h, and glomerulomegaly （glomerular volume 〉 3. 27 × 10^6 μm^3 ） with or without focal segmental glomerulosclerosis （FSGS）. Obesity is defined as a BMI I〉 28. 0 kg/m^2. The subjects were divided into three groups ： mild obesity group with BMI 28.0 to 〈 30 kg/m^2, moderate obesity group with BMI 30 to 〈 35 kg/m^2, and severe obesity group with BMI I〉 35 kg/m^2. Results：Ninety cases were diagnosed as ORG （0. 89% ）, and the frequency rose from 0.62% to 1.0% during last five years （P 〈0. 05）. They were 61 male （67.7%） and 29 female （22. 3% ） with a mean age of （37.5 ± 9. 30） years old. Their mean body mass index was （31.2 ± 3.3） kg/m2, waist circumference was 103 （89.4 - 124） cm in men and 96. 5 （88. 5 - 113） cm in women, waist hip ratio was 0. 95 ± 0. 07, and 100% had visceral obesity. Of the total 49%, 37% and 14% had mild, moderate and severe obesity, respectively. The average of urinary protein excretion was （ 1.48 ± 1.2）g/24h, in 51%, 39% and 10% of cases with proteinuria 0. 4 - 1.0, 1.0 -3.5 and 〉3. 5 g/day, respectively. Mean measured creatinine clearance （Ccr） was （ 109 ± 32. 2） ml/min ~ 1.73 m^2 , in 42% , 36% and 22% with Ccr 〉 120, 90 - 120, and 〈90 ml/min-l. 73 m^2 , respectively. The insulin re- sistance, glucose dysmetabolism, dyslipidemia, and hypertension were observed in 88%, 77%, 76%, and 63%, respec- tively. FSGS was observed in 70%. Mean （x ＋s） foot-process width was （534 ＋ 176）nm. Foot process fusion was ob- served in 36% of cases. Higher BMI was associated with severe proteinuria （ P 〈 0. 05 ）, higher Ccr （ P 〈 0.05 ）, and greater foot-process width （ P 〈 0. 05）. Conclusion ：The prevalence of ORG is increasing rapidly in China. The Most of ORG were male with mild obesity, visceral obesity, minor proteinuria, preserved Ccr and FSGS.