肾小管-间质疾病104例临床病理资料回顾性分析

Retrospective analysis of clinical and pathological data of 104 cases of renal tubular-interstitial disease

目的探讨肾小管-间质疾病的类型与疾病进展的关系,可为临床医生早期诊断及预防提供依据。方法取自哈尔滨医科大学病理学教研室7 112例肾活检资料(1998年1月～2012年4月)中,诊断为肾小管-间质疾病104例,占1.46%(104/7 112)。分析其临床资料,实验室检查和病理检查的相关性。结果①肾小管-间质性疾病的病理变化特点是:肾小球的球囊壁增厚、分层、纤维化,肾小球毛细血管壁增厚、缺血,严重的呈硬化改变;不同程度的肾小管萎缩,间质增生,炎细胞浸润和小动脉壁的增厚。②104例肾小管-间质性疾病中,有无蛋白尿之间有明显的差异(P<0.05);③有无炎细胞浸润和已浸润的多少之间有明显的差异(P<0.05);④而有关肾小球病变、肾小管萎缩、间质增生及临床实验室的其它几项指标间无明显的差异(P>0.05)。结论肾小管-间质性疾病的发生发展与有无炎细胞浸润及浸润的程度密切相关。临床表现为明显蛋白尿的患者,如果排除原发性或继发性肾小球肾炎时,早期诊断和预防可减轻肾小管萎缩、间质增生、纤维化及小动脉增厚、变性的发展。

Objective To investigate the relationship between the type and progression of the renal tubular-interstitial disease,and its value in the early diagnosis and prevention.Methods There were 104 cases of renal tubular-interstitial disease which accounts for 1.46％ in all the 7 112 cases of renal biopsy in the Pathology Department of Harbin Medical University since January 1998 to April 2012.The clinical data,laboratory tests and pathological examination were analyzed.Results ①Pathological changes of tubular-interstital disease：glomerular capsule thickening,delamination,fibrosis,the glomerual capillary wall thickening,ischemia,and even sclerosis ; Varying degress of tubular atrophy,interstitial hyperplasia,inflammatory cell infiltration and thickening of small artery walls.②There was significant difference between cases with and without proteinuria in all the 104 cases of renal tubular-interstitial disease （P ＜0.05）.③There was significant difference between the inflammation cell infiltration and the infiltration amount （P ＜ 0.05）.④There was no significant difference in the indicators of glomerular lesions,tubular atrophy,interstitial hyperplasia and others in the clinical laboratory （P ＞0.05）.Conclusion The occurrence and development of the tubular-interstitial disease are closely related to the inflammatory cell infiltration and its degree.After excluding the possibility of primary and secondary glomerulonephritis for the patients with obvious proteinuria,early diagnosis and prevention can alleviate tubular atrophy,interstitial hyperplasia,fibrosis,and small arteries thickening and degeneration.