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目的观测成人微小病变肾病(MCD)患者在肾病期、部分缓解期、完全缓解后足细胞超微结构的改变,分析其与蛋白尿程度的相关性。方法 2007年1月至2009年6月在北京大学第一医院肾穿刺及外院送检标本确诊为MCD的患者29例,其中肾病期10例、部分缓解期13例、完全缓解后6例,以6例肾肿瘤切除术后患者的正常肾组织作为对照。在透射电镜下观测足突平均宽度、每10μm肾小球基底膜(GBM)上足突个数、足突融合的对应GBM的百分比以及高度与宽度比值分别≥0.5、1.0的“脊”的个数和形态。结果 MCD患者在病变的不同时期均有不同程度的足突融合。无论是在肾病期,还是在部分缓解期和完全缓解后足突平均宽度、每10μmGBM足突个数、足突融合的GBM百分比均比正常对照组高(P<0.05);足突平均宽度和足突融合的GBM百分比与蛋白尿程度呈正相关(r=0.65、r=0.69,P<0.001),单位GBM上的足突数与蛋白尿程度呈负相关(r=-0.52,P<0.001);每10μmGBM“脊”数,随蛋白尿减少而增加:当“脊”高度定义为≥0.5时,完全缓解组与正常对照组无统计学差异(P>0.05);当“脊”高度定义为≥1.0时,完全缓解组仍少于正常对照组(P<0.05)。结论 MCD患者中,随着尿蛋白量的减少,足突宽度变窄、足突融合对应的GBM比例下降、足突数量增多。蛋白尿转阴在前,足突恢复在后。随着恢复程度的增加,“脊”的高度也在增加。
Objective To observe the ultrastructural changes of podocytes in adult minimal change nephropathy (MCD) patients after nephropathy, partial remission and complete remission, and to analyze their correlation with the degree of proteinuria. Methods From January 2007 to June 2009, 29 patients with MCD were diagnosed by renal biopsy and external hospital from the First Hospital of Peking University, including 10 cases of nephropathy, 13 cases of partial remission, 6 cases of complete remission Six patients with renal tumor resection of normal kidney tissue as a control. The average width of the foot process, the number of foot processes per 10 μm glomerular basement membrane (GBM), the percentage of GBM corresponding to the foot process and the ratio of height to width were ≥ 0.5 and 1.0 respectively. The number and shape. Results MCD patients had different degrees of foot process fusion at different stages of the lesion. The GBM percentage of foot process fusion was higher than that of normal control group (P <0.05) at the stage of nephropathy or at the time of partial remission and complete remission. The average width of foot process and The percentage of GBM in foot process fusion was positively correlated with the level of proteinuria (r = 0.65, r = 0.69, P <0.001). The number of foot processes on unit GBM was negatively correlated with proteinuria (r = -0.52, ; Every 10μmGBM “ridges” increased with the decrease of proteinuria: there was no significant difference between the complete remission group and the normal control group when the height of the “ridge” was ≥0.5 (P> 0.05) Ridge "height is defined as> 1.0, the complete remission group is still less than the normal control group (P <0.05). Conclusion In MCD patients, the width of foot process becomes narrower with the decrease of urinary protein, the proportion of GBM corresponding to foot process fusion decreases, and the number of foot processes increases. Proteinuria turned negative in front of the foot process recovery. As the degree of recovery increases, the height of the ridge is also increasing.