塌陷型与细胞型局灶节段性肾小球硬化症的临床病理分析

Clinical and pathological analysis of collapsing and cellular focal segmental glomerulosclerosis

目的分析塌陷型和细胞型局灶节段性肾小球硬化症(focal segmental glomerulosclerosis,FSGS)的临床病理指标与治疗及预后的关系。方法以非特殊型和顶端型FSGS为对照组,回顾性分析塌陷型和细胞型FSGS患者的临床病理特点,随访观察各组患者的治疗效果及预后,探讨FSGS患者肾存活的影响因素。结果 (1)与非特殊型相比,塌陷型、细胞型FSGS患者的病程短,血清白蛋白水平(serum albumin,ALB)低,肾功能不全(renal insufficiency,RI)的发生率高(P<0.05)。(2)塌陷型FSGS的活动性指数和慢性指数显著高于顶端型和非特殊型(P<0.05)。(3)顶端型、细胞型、非特殊型和塌陷型FSGS患者的治疗缓解率由高到低依次为90.6%、58.3%、50%、37.9%,治疗效果与病理亚型密切相关(P<0.05)。(4)顶端型、非特殊型、细胞型和塌陷型FSGS患者的5年肾存活率分别为100%、93.8%、75.0%、58.6%;肾活检时RI、活动性指数、慢性指数、病理亚型、治疗效果是FSGS患者肾存活的影响因素,其中慢性指数≥5分和病理亚型为塌陷型是影响FSGS患者肾存活的独立危险因素(P<0.05)。结论塌陷型和细胞型FSGS是具有明显临床病理特征、对治疗反应及预后较差的病理亚型。慢性指数≥5分和塌陷型是FSGS患者肾存活的独立危险因素。

Purpose To observe the clinical and pathological characteristics of collapsing and cellular focal segmental glomerulosclerosis（ FSGS）,and to analyze their relationship with the clinical treatment and prognosis. Methods The clinical and pathological characteristics of collapsing and cellular FSGS were accessed,not otherwise specified（ NOS） and glomerular tip lesion（ GML） variants served as control groups,with following-up the clinical treatment and prognosis. The influencing factors of renal survival to the patients were also analyzed. Results Compared with NOS,the courses of collapsing and cellular FSGS were shorter,the level of serum albumin（ ALB） in collapsing and cellular FSGS were lower,the rate of renal insufficiency（ RI） in collapsing and cellular FSGS were much higher（ P 〈 0. 05）. The active index and the chronic index of collapsing FSGS were much higher than GML and NOS（ P 〈 0. 05）.The remission rate of each variant was GML（ 90. 6%）,cellular（ 58. 3%）,NOS（ 50%）,and collapsing FSGS（ 37. 9%）. The treatment reactivity was closely related to the variant（ P 〈 0. 05）. The renal 5-year survival rate was GML（ 100%）,NOS（ 93. 8%）,cellular（ 75. 0%）,and collapsing FSGS（ 58. 6%）,respectively,the influence factors of renal survival included the level of serum creatinine（ SCr）,active index,chronic index,the variant,as well as treatment reactivity,of which the chronic index higher than or equal to 5 points and collapsing variant were the independently risk factors（ P 〈 0. 05）. Conclusions Collapsing and cellular FSGS are the pathological variants with clinical and obvious pathological features and poor clinical prognosis. The chronic index higher than or equal to 5 points and collapsing variant are the independently risk factors of renal survival in the patients.