成年人肾小球基底膜厚度及基底膜变薄标准研究

目的 了解成年人肾小球基底膜（GBM）厚度及拟建议薄基底膜肾病（TBMN）的GBM弥漫变薄的标准。 方法 选取肾癌根治性切除患者29例，分析性别、年龄、尿常规、Scr以及既往史、家族史等临床资料。选取远离病灶的肾皮质组织，进行光镜、免疫荧光及透射电镜检查，并进行GBM厚度测量和Ⅳ型胶原α3、α5链免疫荧光检查。 结果 29例中，男15例、女14例，年龄（55.9±14.9）岁（20~80岁），所有病例均无肾脏病家族史。肾组织GBM厚度为（363.6±46.8） nm。GBM厚度与性别相关，男性为（384.0±41.7） nm，女性为（335.0±39.2） nm，差异有统计学意义（P = 0.008）。建议以均数减去两倍标准差作为GBM变薄的标准，即GBM厚度＜270 nm。 结论 成年人肾组织的GBM厚度为（363.6±46.8） nm。GBM厚度和性别相关，男性GBM厚度大于女性，差异有统计学意义。TBMN的GBM弥漫变薄的诊断标准建议为GBM厚度＜270 nm，也建议今后制定TBMN标准中应考虑男女的差异。

Study on the thickness of glomerular basement membrane in adult kidney tissue and the standard of thin glomerular basement membrane

Objective To elucidate the thickness of glomerular basement membrane (CBM) in adult kidney tissue and to establish the standard of GBM thickness for thin basement membrane nephropathy (TBMN) in China. Methods Kidney cortex tissue samples apart from cancer focus were collected from 29 patients undergoing nephrectomy. Clinical data of patients were analyzed. Light, immunofluorescence and electron microscope examinations were performed on these 29 samples to measure the thickness of GBM and the distribution of collagen Ⅳα3, α5 chains. Results There were fifteen male and fourteen female cases with age (55.9±14.9) (20-80) years old. No familial history of renal disease or other diseases was found in these cases. The CBM thickness of these samples was (363.6 ±46.8) nm, which was associated with gender. GBM thickness was (384.0±41.7) nm in male, and (335.0±39.2) nm in female, which was significantly different (P=0.008). The standard to diagnose thin GBM should be the mean minus double standard deviation. So the standard of GBM thickness for TBMN should be <270 nm. Conclusions The GBM thickness of adults is (363.6±46.8) nm. GBM thickness is associated with gender, which is thicker in males with significant difference. It is suggested that the standard of GBM thickness for TBMN in adult should be <270 nm, and the difference of GBM thickness between male and female should be considered too.