梅毒相关性肾病3例分析及文献复习

Clinic Pathological Analysis and Literature Review of 3 Cases of Syphilis-Associated Nephropathy

目的:研究梅毒相关性肾病的临床特点及肾脏病理表现。方法:分析3例经临床、实验室检查及肾脏病理诊断为梅毒相关性肾病患者的临床资料,并复习相关文献。结果:3例患者均为男性,年龄分别为63、47和55岁,均无皮疹表现,1例有左腹股沟淋巴结肿大,1例有下疳,临床均表现为肾病综合征。所有患者快速血浆反应素试验(RPR)(TRUST方法)阳性,梅毒螺旋体抗体(ELISA方法)升高。3例患者均行肾活检,光镜、免疫荧光、电镜检查诊断为膜性肾病。经头孢曲松治疗10d后复查,2例患者蛋白尿完全缓解,1例患者蛋白尿部分缓解。结论:应提高对梅毒相关性肾病的认识,病史、RPR、抗心磷脂抗体、梅毒螺旋体抗体的检测及肾穿刺病理检查是诊断梅毒相关性肾病的重要依据。经抗生素治疗梅毒后,患者肾脏疾病可以完全或部分缓解。

Objective：To study the clinic feature and renal pathology of syphilis-associated nephropathy. Methods： Retrospectively analyze three patients＇ clinic data of syphilis associated nephropathy diagnosed by clinical, laboratory examination and pathological, review the literature. Results： Three male patients were 63, 47 and 55 year-old, respectively. Clinic feature of these cases showing nephrotic syndrome and without rash, one case accompanied with hard chancre and another case with lymph nodes. The renal tissue of these patients were examined by light microscopy, immunofluorescence and electron microscopy, renal pathology confirming membranous nephropathy. On laboratory findings, all three cases with RPR（used TRUST way） positive and elevation of treponema pallidum antibody（used ELISA way）. After treated with ceftriaxone for 10 days, proteinuria was totally resolved in two cases, partially resolved in one case with total resolve after four weeks followup. Conclusions： We should pay attention to each renal patient＇s etiology diagnosis and recognize the syphilis-associated nephropathy. Test of RPR,TPA and ACA should be one of the routine exam for excluding secondary nephropathy. Renal biopsy is the major evi- dence for nephropathy diagnosis.