CAJ | 학술논문

目的对肾小球轻微病变(glomerular minor lesion,GML)进行临床及电镜病理的分类总结,进一步明确该病理表现的性质及意义,探讨其与临床表现的相关性.方法纳入北京协和医院2003年1月7日至2008年12月2日经光镜及免疫荧光病理诊断为GML、同时电镜病理资料完整的患者148例,回顾性分析其临床及病理资料.结果孤立性血尿是患者最常见的临床表现,其次为血尿合并少量蛋白尿及单纯蛋白尿,部分患者可并存高血压、特殊自身免疫表现、肝炎标志物阳性等.经电镜检查明确,GML可最终呈现各种不同的病理表现:薄基底膜肾病(66.2％)、系膜增生性肾小球肾炎(20.3％)、Alport综合征(2.7％)、膜性肾病(3.4％)以及正常组织(4.7％)等.结合临床与病理,表现为孤立性血尿的GML患者,经电镜病理检查诊断为薄基底膜肾病的可能性最大(76.9％).部分患者存在蛋白尿、高血压等提示不良预后的情况.结论 GML只是一种对肾脏病理表现的粗泛描述,对应的电镜病理具有较大异质性,临床意义各异,需积极完善电镜病理,结合临床特点,明确最终诊断,指导治疗.
목적 대신소구경미병변(glomerular minor lesion,GML)진행림상급전경병리적분류총결,진일보명학해병리표현적성질급의의,탐토기여림상표현적상관성.방법 납입북경협화의원2003년1월7일지2008년12월2일경광경급면역형광병리진단위GML、동시전경병리자료완정적환자148례,회고성분석기림상급병리자료.결과 고립성혈뇨시환자최상견적림상표현,기차위혈뇨합병소량단백뇨급단순단백뇨,부분환자가병존고혈압、특수자신면역표현、간염표지물양성등.경전경검사명학,GML가최종정현각충불동적병리표현:박기저막신병(66.2％)、계막증생성신소구신염(20.3％)、Alport종합정(2.7％)、막성신병(3.4％)이급정상조직(4.7％)등.결합림상여병리,표현위고립성혈뇨적GML환자,경전경병리검사진단위박기저막신병적가능성최대(76.9％).부분환자존재단백뇨、고혈압등제시불량예후적정황.결론 GML지시일충대신장병리표현적조범묘술,대응적전경병리구유교대이질성,림상의의각이,수적겁완선전경병리,결합림상특점,명학최종진단,지도치료.
Objective To analyze cases diagnosed with glomerular minor lesion (GML) by light microscopy and immunofluorescence,uncover their final pathology diagnosis by electron microscopy,and thereby clarify the pathological and clinical meaning of GML.Methods One hundred and forty-eight patients receiving renal biopsy between 2003 and 2008 in Peking Union Medical College Hospital,with diagnosis of GML described by light microscopy and immunofluorescence examination were retrospectively studied.All the clinical data and pathological observation were collected and analyzed,including intact results of electron microscopic examination which were considered as golden standards of pathological diagnosis.Results The 148 patients with GML had heterogenous clinical features,with isolated hematuria as the most common presentation.Electron microscopy revealed various pathological presentations:thin basement membrane nephropathy (TBMN,66.2％),mesangial proliferative glomerulonephritis (MsPGN,20.3％),Alport syndrome (2.7％),membranous nephropathy (MN,3.4％),normal tissue (4.7％).Among GML patients with isolated hematuria,TBMN ranked as the most common pathology (76.9％).Conclusions GML is only an equivocal description of pathological manifestation by light microscopy and immunofluorescence examination.And electron microscopy is necessary to obtain accurate pathology diagnosis for patients undergoing renal biopsies.