妊娠相关与非妊娠相关的肾皮质坏死临床病理特征对比研究

Comparison of clinicopathological characteristics between pregnancy and non-pregnancy-related renal cortical necrosis

目的比较妊娠相关与非妊娠相关两种发病因素所致肾皮质坏死(renal cortial necrosis,RCN)的临床病理特征差异。方法回顾性分析2010年1月至2021年5月在北京大学第一医院诊断为RCN的18例患者临床资料,按发病因素分为妊娠相关RCN和非妊娠相关RCN,比较两组患者的临床病理差异。结果妊娠相关RCN 14例,非妊娠相关RCN 4例。妊娠相关RCN主要诱因是产后出血(5例)及子痫(5例),非妊娠相关RCN原因包括感染、低灌注和血栓性微血管病(thrombotic microangiopathy,TMA)。与非妊娠组相比,妊娠相关RCN确诊时间长(40.6 d比24.5 d),急性肾损伤比例更高(100%比0),血红蛋白(78.2 g/L比142.3 g/L)和血小板(45.5×10^(9)/L比195.5×10^(9)/L)更低、乳酸脱氢酶(2046.8 IU/L比219.3 IU/L)更高。经肾活检诊断为RCN的患者中妊娠相关RCN有9例合并TMA,非妊娠相关RCN有1例合并TMA。妊娠组接受血液透析14例,血浆置换12例,非妊娠组均为0例。妊娠组3例进入维持性血液透析,2例接受肾脏移植,非妊娠组均为0例。结论与非妊娠相关RCN相比,妊娠相关RCN发病急,症状重,肾脏缺血更严重,确诊时间长,治疗常依赖血液净化技术,预后差。

Objective To compare the clinicopathological characteristics between pregnancy-related and non-pregnancy-related renal cortical necrosis(RCN).Methods From January 2010 to May 2021,clinical data were reviewed retrospectively for 18 patients who were diagnosed as RCN at Peking University First Hospital.They were divided into two groups of pregnancy-related(n=14)and non-pregnancy-related(n=4).The inter-group differences in clinicopathalogical characteristics were compared.Results There were 14 cases in pregnancy-related group and 4 cases in non-pregnancy-related group.The most common causes of pregnancy-related RCN were postpartum hemorrhage(n=5)and eclampsia(n=5).Non-pregnancy-related causes included infection and thrombotic microangiopathy.Compared with that of non-pregnant group,diagnostic time of RCN was longer in pregnancy group(40.6 d vs 24.5 d),proportion of AKI was higher(100%vs 0),hemoglobin(78.2 g/L vs 142.3 g/L)and platelet(45.5×10^(9)/L vs 195.5×10^(9)/L)level were lower and lactic dehydrogenase level(2046.7 IU/L vs 219.3 IU/L)was higher.TMA features were found in 9 cases in pregnancy group and 1 case in non-pregnancy group.In pregnancy group,hemodialysis(n=13)and plasma exchange(n=12)were offered.However,none received these two treatments in non-pregnancy group.Three cases entered maintenance hemodialysis and 2 cases underwent kidney transplantation(KT)in pregnancy group.However,none received hemodialysis or KT in non-pregnancy group.Conclusion Compared to non-pregnancy-related RCN,pregnancy-related RCN has a more rapid onset and yet a delayed diagnosis and has more severe symptoms and significant renal ischemia.Its treatment often depends on blood purification technology and its prognosis remains poor.