肾小球疾病间质泡沫细胞的分布及其临床病理意义

Significance of renal interstitial foam cells in patients with glomerular disease

目的观测肾间质泡沫细胞浸润常见的肾小球疾病临床类型与病理类型以及各种病理类型肾小球疾病间质泡沫细胞的分布特点及其与病理参数间的关系。方法选取行肾活检的2 862患者为研究对象,观察间质泡沫细胞浸润常见的病理类型及泡沫细胞的分布特点。对诊断明确的Aplort综合征(Aplort syndrome,AS)5例、膜增生性肾小球肾炎(membranous proliferativeglomerulonephritis,MPGN)28例、局灶节段硬化性肾小球肾炎(focal segmental glomerulosclerosis,FSGS)144例、特发性膜性肾病(idiopathic membranous nephropathy,IMN)132例和IgA肾病(lga nephropathy,IgAN)893例按间质是否存在泡沫细胞进行病理参数的比较。结果(1)肾间质泡沫细胞浸润常见于AS患者;原发性肾小球疾病泡沫细胞浸润高发的病理类型依次为MPGN(46.43%)、FSGS(20.14%)、IMN(13.64%)、IgAN(6.27%)。(2)间质泡沫细胞浸润组节段硬化发生率及比例显著高于无泡沫细胞组(P<0.05),其间质纤维化程度亦显著高于无泡沫细胞组(P<0.05)。结论肾间质泡沫细胞浸润常见于AS,但在MPGN、FSGS、IMN和IgAN患者中均可出现。肾间质泡沫细胞的浸润与间质纤维化、肾小球硬化有一定的关联。间质泡沫细胞的出现可能与肾组织慢性化病变形成有关。

Purpose To observe the pathologic types of glomerular diseases which have high renal interstitial foam cells infiltration and to evaluate the relationship between infiltration of foam cells（FC） in renal interstitial tissue and pathologic parameters.Methods A total of 2 862 patients who had received renal biopsy were enrolled in this study.Patients with Alport syndrome（AS,n=5）,membranous proliferative glomerular nephritis（MPGN,n=28）,focal segmental glomerulosclerosis（FSGS,n=144）,idiopathic membranous nephropathy（IMN,n=132）,IgA nephropathy（IgAN,n=893） were divided into two groups：FC ＋ group with foam cells and FC-group without foam cells.Results Infiltration of foam cells in renal interstitial tissue was commonly seen in AS.The frequency of interstitial foam cells was 46.43%in MPGN,20.14%in FSGS,13.64%in IMN,and 6.27%in IgAN.It was found that the segmental glomerular sclerosis and interstitial fibrosis were more severe in FC＋group than that in FC-group.Conclusions The renal interstitial foam cells are most common in patients with AS,but also seen in patients with MPGN,FSGS,IMN and IgAN.There might be a relationship between glomerular sclerosis,interstitial fibrosis and infiltration of foam cells.The present of foam cells in the renal interstitial tissue may contribute to the progression of renal diseases.