国人肾小球大小正常值测定及测量方法探讨

目的 确定国人肾小球大小正常值并探讨肾小球直径测量法。 方法 选择我科1998至2008年肾穿刺病理检查病例中体质量及血糖正常、病理诊断为肾小球轻微病变或薄基底膜肾病的100例患者作为正常值检测组，在其肾小球最大剖面上用直接及间接两种方法测量毛细血管袢直径。同时随意选择体质量及血糖正常的微小病变肾病、局灶节段性肾小球硬化（FSGS）及膜性肾病患者各10例，进行上述肾小球直径测量，并与正常值检测结果比较。 结果 直接和间接测量法结果一致，性别与年龄对肾小球直径无明显影响。通过不同方法获得的肾小球毛细血管袢直径正常值范围如下：（1）含极（血管极、尿极）肾小球：直接法结果为101.3～182.9 μm；间接法为100.3～181.5 μm；（2）含极肾小球加大于它们的无极肾小球：直接法结果为108.5～182.9 μm；间接法为107.6～183.2 μm。另外，30例肾脏病患者的肾小球直径均在此正常值范围内。 结论 本研究应用的两种肾小球直径检测法均可行，获得的国人肾小球直径正常值范围可以推广。

Determination of normal value range of glomerular diameter in Chinese adults with comparison of measurement methods

Objective To determine the normal value range of glomerular diameter in Chinese adults and to investigate the measurement methods.Methods One hundred patients with minor glomerular abnormalities or thin basement membrane nephropathy diagnosed by renal biopsies from 1998 to 2008 with normal body weight and serum glucose were selected for the determination of normal value range of glomerualar diameter.The maximal profile diameter of glomerualr capillary loops wag measured by Motic Med 6.0 image analysis system in the following ways: (1) direct measurement:two perpendicular longest diameters of each glomerulus were measured.(2) indirect measurement:the area of each glomerular capillary loop was measured,then its diameter Was calculated by formula.Ten patients with minimal change disease,10 with focal segmental glomerulosclerosis,and 10 with membranous nephropathy,who all had normal body weight and serum glucose,were also selected for the measurement of glomerular diameter,whose results were then compared with normal values.Results The results obtained from the direct and indirect measurements were not significantly different.The gender and age had no significant effects on glomerular size.The normal value ranges of glomerular maximal profile diameter were as follows:(1) the glomeruli with pole (s) which maximal profiles were with vascular pole and/or urinary pole:the diameter range measured by the direct method was 101.3-182.9 μm,and by the indirect method was 100.3-181.5 μm.(2) the glomeruli with pole (s) and the glumeruli without pole which maximal profiles were without vascular pole or urinary pole,but were bigger than those in smallest glomeruli with pole (s):the diameter range measured by the direct method was 108.5-182.9 μm,and by the indirect method was 107.6-183.2 μm.In addition,the glomerular maximal profile diameters of 30 patients with glomerular diseases were all in the normal value range.Conclusions Direct and indirect measurement methods are both available.The normal value range of glomerular diameter obtained from this study may be used for Chinese adults.