云南高原地区隐匿型肾炎的病理与临床研究

目的探讨云南高原地区隐匿型肾炎的病理类型及与临床表现之间的相互关系,云南地区隐匿型肾炎其病理类型与临床特点.方法对昆明医学院附属延安医院2000年1月至2009年8月间212例进行了肾穿刺活检的隐匿型肾炎患者按尿检异常分为三组：单纯性血尿组92例,单纯性蛋白尿组48例,蛋白尿＋血尿组72例.肾穿刺标本行光镜、电镜及免疫荧光检查,综合分析确定病理诊断,分别观察各组的病理改变与临床的关系,并进行组间对比研究.结果临床类型以单纯性血尿为多（43.4%）,血尿＋蛋白尿次之（34%）,病理类型以IgA肾病为多（50.5%）,系膜增生性肾炎次之（22.2%）,薄基膜肾病的发生率有增加趋势（4.2%）三组中以单纯性血尿组IgAN发生率最高,病理改变最轻,血尿＋蛋白尿组病理改变最重,单纯性蛋白尿组的病理改变次之.血尿＋蛋白尿组与单纯性血尿组和单纯性蛋白尿组比较有统计学意义（P〈0.01）.结论隐匿型肾炎临床症状较少,病理改变与临床表现并不一致,隐匿型肾炎患者应早期进行病理活检,为临床制定及时而合理治疗方案提供依据,减少终末期肾病的发生.

Clinical and Pathological Research on the Patients with Latent Nephritis in Plateau Area of Yunnan Province

Objective To investigate the relationship between the pathological type of latent nephritis and clinical presentation.Methods 212 patients underwent renal needle biopsy from January 2000 to September 2009 were divided into three group acording to their presentation： simple hematuria group（n=92）,simple proteinuria group（n=48）,and hematuria and proteinuria group（n=72）.Pathologic diagnosis was made according to light microscope,electron microscope and immunofluorescence test.The clinical data were retrospectively studied,and the relationship between pathologic diagnosis and the manifestation were analysed.Rsults Simple hematuria was most common in clinical presentation,accounted for 43.5%,the proteinuria and hematuria accounted for 34% of the patients.On pathology type,50.5% were IgA nephropathy,22.2% were mesangioproliferative glomerulonephritis,and 4.2% were thin glomerular basement membrane nephritis.Among three groups,the incidence of IgA nephropathy was the highest and the pathological evaluation was lightest in simple hematuria group.Pathological evaluation was the most severe in proteinuria and hematuria group,but moderate in simple proteinuria groupThere was significant differenc in pthological evaluation among the three groups（P0.05）.Conclusions There is less clinical symptoms in latent nephritis,and there is disparity between pathologicy and clinical presentation.For the patients with latent nephritis,renal needle biopsy should be applied as soon as possible to provide pathological bases for timely and rational therapy,and prevent the incidence of end-stage renal disease.