成人微小病变肾病42例临床分析

Clinicopathological study on 42 cases of patients with minimal change glomerulopathy.

目的回顾性分析微小病变肾病的流行病学资料、临床表现、病理类型及治疗效果。方法选择我院1998年10月～2008年10月经过肾穿刺活检确诊的微小病变肾病患者,分析其年龄、性别等流行病学资料,以及临床表现、病理类型、治疗措施及效果。结果在此期间,我院肾活检数据库中共有微小病变肾病42例,占全部肾活检例数8.2%,男女比例为2.2∶1,年龄平均(32.4±14.4)岁,临床表现均为肾病综合征,均以浮肿为首发症状,病程3d至1年,伴镜下血尿占83.3%,除大量蛋白尿(24h蛋白定量7.04±3.89)g、低蛋白血症TP(38.47±6.54)g/L、ALB(18.57±4.04)g/L、高脂血症TCH(10.41±3.01)mmol/L、TG(3.11±2.72)之外,化验异常还有血钙降低(1.82±0.13)mmol/L、IgG降低(5.21±3.89)g/L、FIB升高(5.56±1.44)g/L、血沉升高(72.05±34.82)mm/h,14.3%伴肾功能不全,其中2例(4.8%)患者需要血液透析治疗,光镜检查可有系膜细胞轻度增生和基质轻微增多、毛细血管基底膜空泡变性、肾小管上皮空泡及颗粒变性,小部分有肾间质炎细胞浸润及灶状纤维化及小动脉管壁增厚,免疫荧光阴性或少量IgA、IgM、C3、FRA沉积,电镜检查均有足突弥漫融合,76.2%对激素治疗敏感,11.9%加用环磷酰,4.8%复发。结论微小病变肾病是肾穿刺活检较常见的病理类型,其临床表现、实验室检查、病理学表现存在一定的特点及规律,多数患者对激素治疗敏感。

Objective To retrospectively analyze the epidemiology data,clinical presentation,pathological changes,therapy protocols and effects of the 42 cases of patients with minimal change glomerulopathy（MCGP）.MethodsThere were totally 42 cases of MCGP from Oct.1998 to Oct.2008 in the database of renal puncture in our hospital.Their epidemiology data such as age,sex etc.was analyzed.The clinical presentation,pathological types,therapeutic protocol and effect were analyzed.ResultsThe number of MCGP patients occupied 8.2% of the total cases of patients with renal biopsy.The age was（32.4±14.4） years old.The male and female ratio was 2.2∶1.All of the patients presented with nephrotic syndrome,with the edema as the first symptom and lasted 3 days to 1 year.Hematuria was seen in 83.3% patient.Other than macroproteinuria（24h urine protein 7.04±3.89g）,hypoproteinemia TP（38.47±6.54）g/L,ALB（18.57±4.04）g/L,hyperlipidemia TCH（10.41±3.01）mmol/L,TG（3.11±2.72）,there was also hypocalcemia Ca（1.82±0.13）mmol/L,low IgG（5.21±3.89）g/L,high FIB（5.56±1.44）g/L and high ESR（72.05±34.82）mm/h.Renal insufficiecy was seen in 14.3% patient,wherein 2 patitents（4.8%） need hemodialysis.There was no glomerular lessions or only minimal focal segmental mesangial prominence under light microscopy.Immunofluorescence microscopy was negative or only with low level staining of IgA,IgM,C3,FRA.Electron microscopy showed effacement of visceral epithelial cell foot processes.76.2% of patients were sensitive to steroid therapy.The rate of relapse was only 4.8%.Conclusion MCGP is one of the common causes of nephrotic syndrome.There are certain features upon its clinical presentation,auxiliary examinations,pathology changes.Most of the patients are responsive to steroid treatment.