80例原发性肾病综合征合并甲状腺功能减退的临床和病理分析

Clinical and Pathological Analysis for 80 Cases of Primary Nephrotic Syndrome Complicating with Hypothyroidism

目的:对80例原发性肾病综合征合并甲状腺功能减退患者的临床特点和病理类型进行分析,探讨其临床意义。方法:本院住院的80例原发性肾病综合征合并甲状腺功能减退患者均进行肾脏病理穿刺、检测甲状腺功能(TT_3、TT_4、FT_3、FT_4及TSH)、血浆白蛋白、24 h尿蛋白定量等,并对其病理类型及临床特点进行分析。结果:肾脏病理类型为:膜性肾病(MGN)43例,微小病变型(MCD)29例,系膜增生性肾炎(MSPGN)4例,局灶节段性肾小球硬化(FSGS)2例,膜增生性肾炎(MPGN)2例。原发性肾病综合征患者血清白蛋白与血清TT_3、FT+3、TT_4、FT_4呈正相关,与血清TSH呈负相关;24 h尿蛋白定量与血清TT_3、FT_3、TT_4、FT_4呈负相关,与血清TSH无明显相关性。结论:原发性肾病综合征合并甲状腺功能减退患者病理类型以膜性肾病和微小病变型多见,甲状腺素水平与白蛋白下降程度密切相关。因此,检测甲状腺素水平对判断原发性肾病综合征患者病变程度、预后及病理类型有重要的参考价值。

Objective： To discuss the clinical significance of 80 patients＇ clinical characteristics and pathological types who have primary nephrotie syndrome complicating with hypothyroidism.Method： 80 patients of primary nephrotie syndrome complicating with hypothyroidism in our hospital were selected, they all received kidney biopsy and thyroid function test （TT3, TT4, FT3, FT4 and TSH ）, plasma albumin, 24 hours urine protein quantitative and so on, and then the pathological types and clinical characteristics were analyzed.Result： The pathological types were membranous g]omerulonephritis （ MGN ） of 43 cases, minimal change disease （ MCD ） of 29 cases, mesangial proliferative glomerulonephritis （ MSPGN ） of 4 cases, focal segmental glomeruloselerosis （ FSGS ） of 2 cases, and membranoproliferative glomerulonephritis （ MPGN ） of 2 cases. For patients with primary nephrotie syndrome, their serum albumin had positive correlation with serum YT3, FT3, TT4, FT4, and had negative correlation with serum TSH; 24 hours urine protein quantitative had negative correlation with serum TT3, FT3, TT4, FT4, and had no obvious correlation with serum TSH.Conclusion： For patients of primary nephrotie syndrome complicating with hypothyroidism, the pathological types arc membranous glomerulonephritis and minimal change disease as the common.The level of thyroxin and albumin decrease have a close correlation.So, the test for thyroxin has an important reference value to judge the lesion degree, prognosis and pathological types for patients with primary nephrotie syndrome complicating with hypothyroidism.