两种肥胖相关性肾小球病临床病理特点的比较

目的 比较两种肥胖相关性肾小球病（ORG），即肥胖相关性肾小球肥大症（OB-GM）及肥胖相关性局灶节段性肾小球硬化症（OB-FSGS）的临床病理特点。 方法 对我科1998年至2008年经肾穿刺病理检查确诊为OB-GM的患者23例及OB-FSGS患者22例，进行临床病理资料回顾性分析。 结果 (1) 两组均为腹型肥胖患者，大部分为中年男性。两组间性别、年龄、体质量指数、腹围差异均无统计学意义。OB-FSGS组的平均病程显著比 OB-GM组长（21.7±29.7）个月比（6.8±9.3）个月，P ＜ 0.05]。（2）两组患者多数伴高血压和糖、脂、嘌呤代谢紊乱，呈现代谢综合征。两组间上述指标差异无统计学意义。(3)与OB-GM组比较，OB-FSGS组尿蛋白量显著增加（2.49±1.58）比（0.83±0.87） g/d，P ＜ 0.05]，血清白蛋白显著降低（38.67±7.00）比（44.05±3.55） g/L，P ＜ 0.01]，Scr显著升高（102.09±25.07）比（87.84±20.63） μmol/L，P ＜ 0.05）]，Ccr显著降低（95.78±37.83）比（128.72±31.20） ml/min，P ＜ 0.01]，禁水12 h尿渗透浓度显著下降（678.72±91.76）比（840.69±133.88） mmol/L，P ＜ 0.01]。（4）两组患者肾小球直径均明显增大，两组间差异无统计学意义。 结论 两种不同病理表现的肥胖相关肾小球病，在病程、尿蛋白量、血清白蛋白和肾功能等方面具有显著性差异。

Comparative study of clinlcopathological features between two kinds of obesity-related glomerulopathy

Objective To compare the clinicopathological features between two kinds of obesity-related glomerulopathy (ORG). Methods Twenty-three patients with obesity-associated glomerulomegaly (OB-GM) and 22 patients with obesity-associated focal and segmental glomerulosclerosis (OB-FSGS) diagnosed by renal biopsy during 1998 to 2008 in our center were enrolled in this study. A retrospective analysis of clinical and pathological data was carried out. Results (1) All the patients in these two groups were with abdominal obesity. Most of them were middle-aged male. There were no significant differences in gender, age, body mass index and waist circumference between these two groups (P>0.05). The mean course of disease in OB-FSGS group was significantly longer than that in OB-GM group(21.7±29.7) vs (6.8±9.3) months,P<0.05]. (2) Metabolic syndrome was found in the most patients of these two groups, but there were no significant differences in the levels of serum glucose, triglycerides, HDL-cholesterul, uric acid and blood pressure between them(P>0.05). (3) The 24-hour urinary protein and Ser level in OB-FSGSgroup were significantly higher than those in OB-GM group(2.49±1.58) vs (0.83±0.87) g/d, P<0.05; (102.09±25.07) vs (87.84±20.63) μmol/L, P<0.05]. The serum albumin level, creatinine clearance and urinary osmotic pressure in the former were significantly lower than those in the latter (38.67±7.00) vs (44.05±3.55) g/L, P<0.01; (95.78±37.83) vs (128.72±31.20) ml/min, P<0.01; (678.72±91.76) vs (840.69±133.88) mmol/L, P<0.01]. (4) The mean glomerular diameters of both OB-FSGS group and OB-GM group were increased, whose difference was not significant (204.3±23.1) vs (205.3±14.3) μm, P>0.05]. Conclusion There are significant differences in the mean course of disease, 24-h urinary protein excretion, serum albumin level and renal function between these two different kinds of ORG.