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目的探讨肾功能正常的抗肾小球基底膜病患者的临床特征和病理特点。方法采取回顾性方法对该院2008年1—12月15例肾功能正常的抗肾小球基底膜病患者(观察组)的临床资料以及同期肾功能损害的25例患者(对照组)进行对比分析。结果观察组15例中3例主要临床表现为水肿,12例临床表现为咯血,诊断为肺出血。5例伴有前驱感染,10例伴有不同程度的肾脏受累,表现为蛋白尿与镜下血尿。15例患者均经受肾穿刺活检检查,免疫荧光法显示:IgG2+~3+沿着肾小球毛细血管襻呈现线样沉积;光镜检查显示:10例显示轻度的病变,1例未见有明显的病变,4例伴有轻度系膜细胞增生与系膜基质增多;电镜显示:2例抗肾小球基底膜病合并IgG肾病系膜区显示有电子致密物沉积。观察组与对照组血红蛋白、抗肾小球基底膜病抗体和肾小球新月体比较差异有统计学意义(P<0.05)。观察组肾存活率为100.0%(15/15),对照组肾存活率为48.0%(12/25),观察组肾存活率明显的高于对照组肾存活率,数据的比较差异有统计学意义(P<0.05)。结论临床中肾功能正常的抗肾小球基底膜病患者的肾脏病理较轻,且预后效果比较好。
Objective To investigate the clinical features and pathological features of patients with anti-glomerular basement membrane disease with normal renal function. Methods The clinical data of 15 patients with anti-glomerular basement membrane disease (observation group) with normal renal function and the 25 patients with renal dysfunction (control group) in the same hospital from January to December in 2008 were retrospectively analyzed. analysis. Results The observation group of 15 cases in 3 cases of the main clinical manifestations of edema, 12 cases of clinical manifestations of hemoptysis, diagnosis of pulmonary hemorrhage. 5 cases with prodromal infection, 10 cases with varying degrees of renal involvement, manifested as proteinuria and microscopic hematuria. Fifteen patients underwent renal biopsy. Immunofluorescence showed that there was linear deposition of IgG2 + ~ 3 along the glomerular capillaries. Light microscopy showed that 10 cases showed mild lesions and 1 case had no Obvious lesions, 4 cases with mild mesangial cell proliferation and mesangial matrix increased; electron microscopy showed: 2 cases of anti-glomerular basement disease with IgG nephropathy mesangial area showed deposition of electron-dense material. There was significant difference between hemoglobin, anti-glomerular basement membrane antibody and glomerular crescent in observation group and control group (P <0.05). The renal survival rate was 100.0% (15/15) in the observation group and 48.0% (12/25) in the control group. The renal survival rate in the observation group was significantly higher than that in the control group, and the difference was statistically significant Significance (P <0.05). Conclusions The renal pathology of patients with anti-glomerular basement membrane disease with normal renal function in clinic is relatively mild and the prognosis is good.