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目的 :了解非何杰金淋巴瘤 (NHL)肾脏损害的临床特征和肾脏病理表现。 方法 :收集住院患者 8例临床资料及其中 6例肾活检病理资料加以分析。 结果 :① 8例NHL患者诊断为 :T细胞淋巴瘤 3例 ,小B细胞淋巴瘤 2例 ,大B细胞淋巴瘤 1例 ,皮肤T细胞淋巴瘤 1例 ,B细胞淋巴瘤 1例。②首发症状 :以肉眼血尿、下肢水肿和皮疹起病各 2例 ,以发热伴少尿及关节痛伴口腔溃疡各 1例。③肾外损害 :发热 4例 ,皮疹 5例 ,淋巴结肿大 7例 ;多数患者合并贫血和白 /球蛋白比下降或倒置 ;血清抗核抗体阳性 3例 ,低补体血症 5例 ,抗中性粒细胞胞浆抗体 (ANCA)阳性 1例。④肾脏损害 :临床表现尿检异常 3例 ,急性肾衰 4例 ,慢性肾衰 1例 ;⑤ 6例行肾活检病理改变分别为 :毛细血管内增生性病变 (2例 ) ,膜增生样病变 (3例 ) ,轻度系膜增生性病变 1例 ;免疫荧光可见较多免疫复合物沉积 ,尤其是补体C1q沉积 ;2例小B细胞淋巴瘤患者伴间质淋巴瘤细胞浸润。 结论 :NHL肾脏损害从轻度尿检异常至急性肾衰不等 ,肾脏病理多为急性增殖性病变 ;肾外损害除了发热、贫血等表现外 ,多数患者还有皮疹 ,低补体血症 ,甚至自身抗体和ANCA阳性 ,类似系统红斑狼疮和系统性血管炎 ,临床需注意鉴别。
Objectives: To understand the clinical features and renal pathology of non-Hodgkin’s lymphoma (NHL). Methods: Eight cases of inpatients were collected and their pathological data of 6 cases were analyzed. Results: Eight cases of NHL were diagnosed as T cell lymphoma in 3 cases, small B cell lymphoma in 2 cases, large B cell lymphoma in 1 case, cutaneous T cell lymphoma in 1 case and B cell lymphoma in 1 case. The first symptom: with gross hematuria, edema and skin rash onset in 2 cases, with fever and oliguria and joint pain with oral ulcer in 1 case. ③ extrahepatic damage: fever in 4 cases, 5 cases of rash, lymph node enlargement in 7 cases; most patients with anemia and white / globulin ratio decreased or inverted; serum anti-nuclear antibody positive in 3 cases, hypocomplementemia in 5 cases, anti- One case of positive granulocyte cytoplasmic antibody (ANCA). ④ kidney damage: abnormal urinalysis in 3 cases of clinical manifestations, acute renal failure in 4 cases, 1 case of chronic renal failure; ⑤ 6 cases of pathological changes of renal biopsy were: capillary proliferative lesions (2 cases), membranoproliferative lesions 3 cases), mild mesangial proliferative lesions in 1 case; immunofluorescence showed more immune complex deposition, especially complement C1q deposition; 2 cases of small B cell lymphoma with interstitial lymphocytic infiltration. CONCLUSION: NHL renal damage varies from mild abnormal urinalysis to acute renal failure. Renal pathology is mostly acute proliferative disease. In addition to the manifestations of fever and anemia, most patients also have rash, hypocomplementemia, and even their own Antibodies and ANCA positive, similar to systemic lupus erythematosus and systemic vasculitis, the clinical need to pay attention to identify.