左肾静脉压迫综合征伴蛋白尿患者肾脏病理分析

目的通过对23例左肾静脉压迫综合征伴蛋白尿患者肾脏病理及尿相关指标进行分析，以了解该类患者肾脏病理与临床指标的关系。方法将23例确诊为左肾静脉压迫综合征且伴有蛋白尿的患者，均行右侧肾脏活组织病理检查，所有病例肾脏体积大小正常，血肌酐〈132umol／L。同时留尿检测视黄醇结合蛋白（RBP）、H2微球蛋白（132-MG）、蛋白肌酐比值（PCR）、白蛋白肌酐比值（ACR）、乙酰pD氨基葡萄糖苷酶（NAG）、尿渗透压（尿渗量）、尿蛋白电泳（UPEP）、可滴定酸（TA）、铵（NH4＋）检测，对照组做相同指标检测。结果①肾活组织病理检查：23例患者中，合并不同程度的系膜增生者15例（占65．2％），其中10例伴有IgA沉积（Lee分级Ⅱ级7例，Ⅲ级3例），5例系膜增殖性肾炎；8例光镜下肾小球无异常改变，均有间质、小管、血管轻微病变，炎细胞浸润较少见。②PCR、ACR病理异常组较病理正常组及对照组高（P〈0．05），病理正常组较对照组有统计学差异（P〈0．05）；12例PCR〉1000mg／g的患者中，11例肾脏病理有异常；11例PCR〈1000mg／g的患者中，仅4例肾脏病理异常，且病变较轻，2组比较有统计学差异（P〈（）．05）。③尿蛋白电泳：病理异常组〈33KDA／70KDA、160KDA／70KDA、〉160KDA／70KDA比值均较病理正常组及对照组高（P〈0．05）；病理正常组〈33KDA／70KDA、160KDA／70KDA比值均较对照组为高，〉160KDA／70KDA比值无表达。④尿NAG、RBP、H2一MG肾脏病理异常组和肾脏病理正常组均高于正常对照组（P〈0．05），肾脏病理异常组和肾脏病理正常组比较无统计学差异（P〉O．05）；TA、NH4＋、渗透压三组比较均无统计学差异（P〉0．05）。结论左肾静脉压迫综合征患者伴蛋白尿患者中，有65．2％患者合并肾脏病理异常，均存在肾小管损伤，以近端。肾小管为主，病理异常者较重；尿蛋白肌酐比值〉1000mg／g和（或）大分子量蛋白尿的存在可作为左。肾静脉压迫综合征合并肾脏病的指标。

Kidney pathological changes and urine-related variables of left renal vein entrapment syndrome with pro-teinuria

Objective To investigate the kidney pathological changes and urine-related variable of the left renal vein entrapment syndrome with proteinuria. Methods Twenty-three cases of left renal vein entrapment syndrome with proteinuria were subjected to renal biopsy. The renal size was normal, and serum creatinine 132/mol/L in all cases. Urinary retinol binding protein （RBP）, Beta2-micro- globulin （132-M）, protein ereatinine ratio （PCR）, albumin creatinine ratio （ACR）, immunoglobulin G （IgG）,N-acetyl-l-D glucosaminidase （NAG）, urine osmotic pressure （UOSM）, urinary protein elec- trophoresis （UPEP）,titratable acid （TA）,and ammonina （NH4 ＋ ） were measured. Results In 23 ca- ses of left renal vein entrapment syndrome with proteinuria,the renal pathological changes occurred in 65.2%（n = 15）：10 cases had IgA deposition, 15 cases had mesangial proliferative glomerulonephritis, and 8 cases were normal. Urinary ACR and PCR were significantly higher in proteinuria group than in non- proteinuria group and control group （P0. 05）. Eleven cases out of 12 patients with PCR1000 mg/g had renal pathological changes. In 11 cases with PCR〈1 000 rag/g, only 4 cases had renal path- ological changes. There was significant difference between two groups （P〈0. 05）. Protein molecular weight ratio of 33 KDA/70 KDA, 160 KDA/70 KDA, 160 KDA/70 KDA in abnormal pathologygroup was significantly higher than in normal pathology group and control group. Protein molecular weight ratio of 33 KDA/70 KDA, 160 KDA/70 KDA in normal pathology group was higher than in control group. Urine 132-M and RBP were significantly higher in proteinuria group and non-proteinuria group than in control group, but there was no significant difference between proteinuria group and non- proteinuria group （P〉0. 05）. UOSM, TA, and NH4 ＋ had no statistically significant difference among three groups. Conclusions 65.20/oo of left renal vein entrapment syndrome patients with proteinuria have renal pathological changes, and all patients suffer from proximal renal tubule injury. In left renal vein entrapment syndrome with proteinuria, high molecular weight protein exists and （or） PCR 1 000 mg/g, which can be used as a measure indicator to estimate kidney diseases.