伴有新月体形成的原发性肾小球肾炎的临床与病理分析

The clinical and pathological analysis of primary glomerulonephritis with crescent formation

目的探讨伴有新月体形成的原发性肾小球肾炎的临床与肾脏病理特点。方法回顾性分析84例伴有新月体形成的原发性肾小球肾炎患者,男性37例,女性47例;年龄(36.13±4.56)岁。按新月体形成所累及的肾小球比例分为2组,即<10%组和>10%组,分析临床表现、肾活检病理诊断类型及其预后。结果血尿<10%组镜下血尿15例,>10%组为27例。蛋白尿<10%组尿蛋白<1.0 g·d-1者20例,尿蛋白>1.0g·d-1者19例;>10%组尿蛋白<1.0g·d-1者13例,尿蛋白>1.0g·d-1者32例。肾功能:血肌酐<133μmol·L-1者<10%组34例,>10%组29例;血肌酐>133μmol·L-1者<10%组5例,>10%组16例,其中急性肾功能衰竭共6例,<10%组及>10%组各3例,慢性肾功能衰竭16例,<10%组2例,>10%组14例。其中高血压:<10%组24例,>10%组32例。肾活检病理诊断中IgA肾病75例,膜性肾病3例,2型原发性新月体肾炎2例,膜增生肾小球肾炎1例,局灶增生硬化性肾小球肾炎1例,系膜增生性肾小球肾炎1例,局灶节段肾小球硬化症1例;2组间血尿、蛋白尿及血肌酐水平差异有统计学意义(P<0.05),而高血压的发生率差异无统计学意义(P>0.05)。结论原发性肾小球肾炎的肾脏病理多样,如果伴有新月体形成,则进展恶化快,预后差。因此,应尽早行肾活检明确病理诊断,早期治疗可改善预后。

Objective To investigate and analysis the clinical and pathological features of primary glomerulonephritis with cres- cent formation. Methods 84 primary glomerulonephritis patients with crescent formation were retrospectively analyzed. There were 37 male cases and 47 female cases;Mean age was （36.13 ± 4.56） years old. The patients were divided into two groups according to the per- centage of crescent formation： group A （ 〈 10% ）, group B （ 〉 10% ）. The clinical manifestation, renal biopsy pathology types, and prog- nosis of disease were analyzed. Results Hematuria： there were 15 patients in group A and 27 cases in group B;Proteinuria： in group A,there were 20 cases with urine protein 〈 1.0 g· d^-1 ,and 19 cases with urine protein 〉 1.0 g · d^-1 ;in group B,there were 13 cases with urine protein 〈 1.0 g ·d^-1 ,and 32 cases with urine protein 〉 1.0 g · d^-1 ;Renal function：there were 34 cases in group A and 29 cases in group B regarding serum creatinine 〈 133 μmol· L^-1 ;there were 5 cases in group A and 16 cases in group B regarding serum creatinine 〉 133 μmol · L^-1. there were 16 patients with acute renal failure,2 cases in group A and 14 cases in group B;High blood pressure ： A total of 56 patients with hypertension,24 cases in group A and 32 cases in group B. Renal pathology types ： there were 75 ca- ses with IgA nephropathy,3 cases with membranous nephropathy,2 cases with type 2 primary crescent nephritis （RPGN）, 1 case with membrane glomerulonephritis, 1 case with focal sclerosing glomerulonephritis, 1 case with focal proliferative glomerulonephritis, and t case with focal segmental glomerulosclerosis. Hematuria, proteinuria, and the serum levels of serum creatinine between the two groups was sta- tistically difference （P 〈 0. 05 ）, while the incidence of hypertension showed no statistical difference （P 〉 0. 05 ）. Conclusion The renal pathology feature of primary glomerulonephritis are of variety. If accompanied by crescent formation, deteriorating is fast and prognosis is poor. Renal biopsy is needed as soon as possible to definite pathological diagnosis, and early treatment can improve prognosis.