足突融合与IgA肾病肾小球硬化及蛋白尿的相关性分析

目的:探讨足突融合与IgA肾病肾小球硬化及蛋白尿的相关性.方法:对1998年1月至2005年1月间肾活检诊断为IgA肾病-局灶硬化性肾小球肾炎(IgAN-FGS)99例进行超微病理观察并与病理及临床进行联系分析.结果:电镜下显示肾小球脏层上皮细胞足突广泛融合24例(占24.2%),足细胞无明显改变(包括足突细胞部分融合)75例(占75.%).广泛足突细胞融合组的重度肾小球硬化发生率为54.2%(13/24)明显高于足细胞无明显改变组的28.0%(21/75);临床表现尿蛋白≥2.0 g/d组24例(占24.2%),尿蛋白＜2.0 g/d组75例(占75.8%).尿蛋白≥2.0 g/d组足突广泛融合的发生率为45.8%(11/24)明显高于尿蛋白＜2.0 g/d组的17.3%(13/75),结论:IgAN-FGS足细胞融合与肾小球硬化的加重及尿蛋白排泄量增加呈正相关,广泛足突融合可作为IgAN-FGS病变进展的一个病理学标志,尿蛋白≥2.0 g/d可作为间接反映IgAN-FGS病变进展的一个临床标志.

Correlation analysis of foot processes fusion and glomerulosclerosis and proteinuria in IgA nephropathy

Objective:To investigate the relationship between foot processes fusion and glomerulo- sclerosis and proteinuria in IgA nephropathy. Methods: Ninety-nine patients with IgAN-FGS diagnosed by renal biopsy from January 1998 to January 2005 were enrolled in this study. Ultramicro-pathological and pathological and clinical findings were compared. Results: Foot processes of podocytes fused extensively in 24 patients (24.2%). Foot processes of podocytes did not change obviously (including foot processes fused partly) in 75 patients (75.8%). The incidence of serious glomerulosclerosis in the group whose foot processes of podocytes fused extensively (13/24,54.2%) was higher significantly than that of the group whose foot processes of podocytes did not change obviously (21/75,28.0%). Urine protein was more than 2.0 g every day in 24 patients (24.2%). Level of urine protein was less than 2.0 g every day in 75 patients (75.8%). The incidence of foot processes fusion extensively in urine protein more than 2.0 g every day group (11/24,45.8%) was higher significantly than that of urine protein less than 2.0 g every day group (13/75,17.3%). Conclusions: The foot processes fusions are positively correlated to the aggravation glomerulosclerosis and to the increasing of excretaion of proteinuria. The extensive foot processes fusion can be used as a pathological mark of the progress of IgAN-FGS. That protein of urine more than 2.0 g every day can be a indirect mark of the progress of IgAN-FGS.