恶性高血压性血栓性微血管病的临床病理分析

目的分析恶性高血压(MHT)性血栓性微血管病(TMA)的临床病理特点与预后的相关性.方法2010年9月至2019年9月经肾活检确诊的MHT患者21例,分为肾炎组(GN组,7例)和原发性高血压组(HT组,14例).结果所有患者均有肾功能不全和蛋白尿.两组患者发病年龄、病程、血压、尿蛋白水平、血尿、贫血及血小板减少发生率差异无统计学意义.HT组肥胖、糖尿病比例高于GN组.GN组血白蛋白水平显著低于HT组.两组患者肾组织病理学特点、免疫荧光和电镜结果存在差异.GN组患者肾小球、小管间质及血管病变程度一致,动脉病变以慢性病变为主.HT组肾小球病变轻,肾小球硬化比例明显低于GN组,小动脉可见急性、慢性病变并存.HT组2例患者就诊后1年尿检转阴,血肌酐仍上升,行肾活检仍可见小动脉急性病变,其中1例6年后进展至终末期肾衰.结论恶性高血压性血栓性微血管病的肾组织病理特点、免疫荧光、电镜改变及预后与病因有关,肾活检是明确病因的有效手段.经过积极降压治疗部分患者可好转,部分患者动脉病变仍可进展.

Objective To evaluate the clinicopathological feature*and prognosis of thrombotic microangiopathy associated with malignant hypertension.Method 7 IgA neprhopathy patients(ON group)ami 14 primary hypertension patients(HT group)were retrospectively analyzed.Results All patients presented abnormal renal function and proteinuria.There was no significant difference in the age,disease duration,serum creatinine,blood pressure,urinary protein excretion,anemia and thrombocytopenia between two groups.Serum albumin was lower in the GN group.The glomerulosclerosis ratio,tubulointerstit.il and chronic arteriole lesion were parallel in CIN group.In HT group,glomerular lesion were mild and chronic and acute arteriole lesions coexist.Untie protein level in 2 HT cases decreased to normal range after I year and renal pathology revealed acute arteriole lesions.Conclusion There are some differences in pathological charactcnstics and prognosis between the GN group and HT group.