CAJ | 학술논문

目的观察IgA肾病伴恶性高血压(IgAN-MHT)患者的临床病理特点,评价肾脏小动脉和微动脉病变,探讨肾小管周毛细血管(PTC)缺失和肾小管间质巨噬细胞浸润与临床表现的相关性.方法 2003年1月至2012年3月在北京协和医院经肾活检确诊的1765例原发性IgA肾病患者,共34例(1.9％)临床病理确诊为IgAN-MHT,收集临床资料,半定量分析肾小球、肾小管、肾间质及肾血管病变,免疫组化染色方法评价PTC(CD34+)缺失、肾小管间质巨噬细胞(CD68+)浸润情况,及其与临床指标的相关性.结果 IgAN-MHT多见于青年男性,除血压显著升高外,表现为不同程度的肾功能损害和蛋白尿；小动脉和微动脉均有不同程度的急、慢性病变共存现象,但二者与肾功能没有显著相关性；肾间质有显著巨噬细胞浸润,与肾功能显著相关,PTC缺失表现亦突出,PTC面积比例与肾功能呈良好的相关性.结论 IgAN-MHT患者肾脏微动脉和小动脉病变与肾功能相关性差,肾小管间质巨噬细胞浸润和PTC缺失表现突出并与肾功能损害相关.
목적 관찰IgA신병반악성고혈압(IgAN-MHT)환자적림상병리특점,평개신장소동맥화미동맥병변,탐토신소관주모세혈관(PTC)결실화신소관간질거서세포침윤여림상표현적상관성.방법 2003년1월지2012년3월재북경협화의원경신활검학진적1765례원발성IgA신병환자,공34례(1.9％)림상병리학진위IgAN-MHT,수집림상자료,반정량분석신소구、신소관、신간질급신혈관병변,면역조화염색방법평개PTC(CD34+)결실、신소관간질거서세포(CD68+)침윤정황,급기여림상지표적상관성.결과 IgAN-MHT다견우청년남성,제혈압현저승고외,표현위불동정도적신공능손해화단백뇨；소동맥화미동맥균유불동정도적급、만성병변공존현상,단이자여신공능몰유현저상관성；신간질유현저거서세포침윤,여신공능현저상관,PTC결실표현역돌출,PTC면적비례여신공능정량호적상관성.결론 IgAN-MHT환자신장미동맥화소동맥병변여신공능상관성차,신소관간질거서세포침윤화PTC결실표현돌출병여신공능손해상관.
Objective To observe the vascular lesions of renal small arteries and arterioles as well as clinco-pathological characteristics among patients with IgA nephropathy associated with malignant hypertension (IgAN-MHT).To explore the clinical significance of peritubular capillary (PTC) loss and renal tubulointerstitial macrophage infiltration in the same population.Methods Thirtyfour (1.9％) IgAN-MHT patients were diagnosed among the 1765 cases of primary IgA nephropathy in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical records were reviewed and the lesions of glomeruli,tubules,interstitium and renal vessels were semi-quantitatively re-evaluated.PTC and renal tubulointerstitial macrophages were demonstrated by immunohistochemical staining.Results The IgAN-MHT patients were mainly young males with very high blood pressure.They had variant renal function impairment and urinary protein excretion.Acute and chronic vascular changes coexisted in the renal small arteries and arterioles,but all the vascular lesions failed to correlate with renal function.The renal tubulointerstitial macrophage infiltration was prominent and correlated well with renal function.PTC loss was also prominent and the PTC proportion was correlated with renal function.Conclusions In IgAN-MHT patients,the renal vascular changes do not correlate with renal function,but PTC loss and renal tubulointerstitial macrophage infiltration are both prominent and may reflect renal function impairment.