特发性膜性肾病伴高尿酸血症患者临床及病理特点分析

Clinical and pathological features of idiopathic membranous nephropathy patients combined with hyperuricemia

目的探讨特发性膜性肾病(idiopathic membranous nephtopathy,IMN)伴高尿酸血症患者的临床及病理特点。方法回顾性分析浙江省人民医院2014年1月至2017年1月经肾活检确诊为IMN的患者125例。根据血尿酸水平将125例IMN患者分为血尿酸正常组77例和高尿酸血症组48例,比较2组的临床资料和病理学特征。结果 125例IMN患者中,高尿酸血症组肌酐、血尿素氮比血尿酸正常组水平高(P<0.05);估算肾小球滤过率(estimated glomerular filtration rate,eG FR)比血尿酸正常组水平低(P<0.05)。24h尿蛋白定量、总蛋白、白蛋白、胆固醇、三酰甘油、低密度脂蛋白、三碘甲状腺原氨酸、甲状腺素、促甲状腺激素指标跟血尿酸正常组相比,差异均无统计学意义(均P>0.05)。肾组织光镜下高尿酸血症组肾小球球性硬化、节段硬化、肾小管萎缩/间质纤维化比例比正常血尿酸组高(P<0.05),2组患者病理改变均以Ⅰ期、Ⅱ期为主,系膜增生均以轻度增生为主,2组小动脉壁增厚、小动脉透明变性差异均无统计学意义(均P>0.05)。高尿酸血症组电镜下系膜区致密物沉积比例比正常血尿酸组高(P<0.05)。2组患者免疫病理都以免疫球蛋白IgG和补体C3的沉积为主,同时伴较多的免疫球蛋白IgM沉积及少量的补体C1q沉积,2组间差异均无统计学意义(P>0.05)。结论 IMN伴高尿酸血症的患者显示其肾小球和肾小管间质病变更明显,高尿酸血症可能为IMN患者病情进展的重要因素。

Objective To investigate the clinical and pathological features of idiopathic membranous nephropathy（ IMN） patients combined with hyperuricemia. Methods A retrospective analysis was conducted by collecting 125 cases of IMN diagnosed by renal biopsy in our hospital between January 2014 and January 2017. According to the serum uric acid level,the enrolled patients were further divided into two groups： normal serum uric acid group（ n = 77） and hyperuricemia group（ n = 48）,and the clinical data and pathological features of the two groups were compared subsequently. Results In the 125 patients with IMN,the serum creatinine and blood urea nitrogen levels were significantly higher and the estimated glomerular filtration rate was significantly lower in the hyperuricemia group than those in the normal serum uric acid group（ P〈0. 05 for all）. Furthermore,there were no significant differences in 24-h urinary protein quantity,total protein,albumin,cholesterol,triglyceride,low-density lipoprotein,as well as thyroid function indexes of T3,T4 and TSH between the hyperuricemia group and normal serum uric acid group（ P〉0. 05 for all）. Renal tissue examination results under light microscope suggested that glomerulus sclerosis,segmental glomerulosclerosis,tubular atrophy/interstitial fibrosis ratio were significantly increased in the hyperuricemia group than those in the normal serum uric acid group（ P〈0. 05 for all）. Meanwhile,pathological changeswere stage I and stage II mainly in the two groups and mesangial hyperplasia was mild predominantly,and there was no statistically significant difference in the arteriole hypertrophy and arteriolar hyaline degeneration between two groups（ P〉0. 05）. In the hyperuricemia group,the proportion of dense deposits in the mesangial region was higher than that in the normal serum uric acid group under electron microscopy（ P〈0. 05）. Immunopathologic features of patients in both two groups were dominated by immunoglobulin Ig G and complement C3 deposition,accompanied by some immunoglobulin Ig M deposition and a small amount of complement C1 q deposition,with the difference between the two groups being not statistically significant（ P〉0. 05）. Conclusions IMN patients with hyperuricemia show marked changes in glomerular and tubulointerstitial diseases,and hyperuricemia may be an important factor in the progression of IMN.