伴重度肾小管间质病变系膜增生性肾炎的临床病理特征

The clinical and pathologic characteristics of mesangial proliferative glomerulonephritis with severe tubulointerstitial impairment

目的：探讨伴重度肾小管间质病变的系膜增生性肾小球肾炎（ＭｓＰＧＮ）的临床病理特征及有效治疗方法。方法：回顾分析５３例伴不同程度ＭｓＰＧＮ患者的临床和病理资料。结果：①ＭｓＰＧＮ患者可表现为肾病综合征、水肿和尿蛋白多＞１．５ｇ／２４ｈ，血尿少见，贫血、低渗尿常见；②易发生肾功能不全（１０例重度病变者中有３例）；③对激素治疗抵抗（重度病变组９例经激素治疗者中有５例）；④肾脏病理改变除系膜增殖外，多伴有不同程度的小球硬化等损害，其中节段硬化２例；⑤间质淋巴细胞亚群数量增加，ＣＤ＋４细胞、ＣＤ＋８细胞均增加，以ＣＤ＋８细胞为主，ＲＴ值＜１。结论：ＭｓＰＧＮ时肾功能不全发生率高，对激素治疗反应差，治疗上不应过分强调使用激素。

Objective:To study the clinical and pathologic characteristics of mesangial proliferative glomerulonephritis (MsPGN) with severe tubulointerstitial impairment,and to seek the effective therapy method for MsPGN.Methods:The clinical and pathologic data were retrospectively analyzed in 53 cases with MsPGN concomitant with severe tubulointerstitial impairment.Results:The clinical manifestations included nephrotic syndrome,edema,urine protein over 1 5 g/24 h,and frequently anemia as well as hypotonic urine were seen,but hematuria seldom appeared.These patients were liable to developing renal failure (3 out of 10 cases) and resistant to glucocorticoid treatment (5 out of 9 cases).In addition to mesangial proliferative lesions in kidney,there was sclerosis in various extent,and there was segmental sclerosis in 2 cases .Both CD + 4 and CD + 8 lymphocyte subpopulations increased in interstitium,particularly CD + 8 lymphocyte (CD + 4/CD + 8 ratio<1).Conclusions:In MsPGN concomitant with severe tubulointestitial impairment the incidence of renal failure appears to be high and the curative effect of glucocorticoid is poor.These data indicate that in the treatment strategy emphasis should be put on renal function protection rather than glucocorticoid application.