AITD合并肾小球肾炎自身抗体检测及临床病理分析

目的：观察自身免疫性甲状腺疾病合并肾小球肾炎的甲状腺自身抗体表达及临床病理特点。方法：自1998年～2007年行肾活检的肾小球肾炎合并AITD患者20例,分析其甲状腺自身抗体表达及临床与病理特点。结果：AITD 20例（男6,女14）,平均年龄（35.7±9.4）岁,Graves’病9例,桥本氏甲状腺炎5例,甲减6例。甲状腺球蛋白抗体（TGA）、甲状腺微粒体抗体（TMA）、甲状腺过氧化物酶抗体（TPO-Ab）三种自身抗体中,TPO-Ab阳性率较高。肾损害表现为隐匿性肾炎3例,慢性肾小球肾炎8例,肾病综合征6例,急进性肾炎3例。病理提示膜性肾病9例,4例为系膜增生性肾小球肾炎,3例为坏死性肾小球肾炎,2例为局灶节段硬化,2例为系膜毛细血管性肾炎。结论：自身免疫性甲状腺疾病合并肾小球肾炎肾损害主要表现为慢性肾炎和肾病综合征,肾脏病理类型多为膜性肾病,TPO-Ab阳性率较高。大多数患者预后较好。

Determination of Serum Thyroid Auto-antibodies and Renal Biopsy Study in Patients with Concomitant AITD and Glumerular Nephropathy

Objective To study the thyroid auto-antibody and renal pathology in patients with conco-mitant AITD and glumerulo-nephritis.Methods Clinical and renal biopsy pathologic data as well as serum thyroid auto-antibodies of 20 patients with conco-mitant glomerular nephropathy and AITD were reviewed.Results The patients consisted of 6 males and 14 females,and their mean age was 35.7±9.4 year old.Regarding AITD,9 patients had Grave disease（GD）,5 patients had Hashimoto thyroiditis（HT）,and 6 patients had hypothyroidism.Among the three thyroid auto-antibodies（TPO-Ab,TGA,TMA）,the psoitive rate of TPO-Ab was the highest.Regarding nephropathy,4 patients had latent glomerulonephritis,8 patients had chronic glomerulonephritis,6 patients had nephrotic syndrome（NS）,and 3 patients had rapidly progressive glomerulonephrits.Light microscope examination showed that 9 patients had membranous glomerulopathy（MN）,4 patients had mesangial proliferative glomerulonephritis,3 patients had crescentic glomerulonephritis,2 patients had focal segmental glomerular sclerosis（FSGS）,and 2 patients had mesangiocapillary glomerulonephritis（MPGN）.Conclusion The most common types of renal disease in patients with AITD were chronic glomerulonephritis or nephotic syndrome,and MN was the major pattern in these patients.High titer of TPO-Ab was more common in the patients.The prognosis of most patients was good.