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目的:观察肾小球疾病患者肾间质泡沫细胞的分布特点,分析其与临床表现及肾组织病理改变之间的联系。方法:选取经临床病理明确诊断的Alport综合征(AS)125例,特发性膜性肾病(IMN)192例,IgA肾病(IgAN)388例,局灶节段性肾小球硬化(FSGS)137例。观察肾组织泡沫细胞的分布,并对肾间质有无泡沫细胞患者的临床和病理进行比较。结果:(1)AS、IMN、IgAN、FSGS四种疾病肾组织中均存在肾间质泡沫细胞,发生率分别为64.8%、21.4%、12.4%、36.5%,其中以AS中最为多见。(2)肾间质泡沫细胞组肾小球节段硬化的发生率及硬化比例均显著高于无泡沫细胞的对照组,AS、IgAN患者泡沫细胞组间质纤维化程度重于对照组。(3)AS、IgAN患者肾间质泡沫细胞组尿蛋白、血脂水平显著高于对照组(P<0.01)。FSGS患者肾间质泡沫细胞组三酰甘油水平显著高于对照组,但两组间尿蛋白水平未见差异。结论:肾间质泡沫细胞在AS、IMN、IgAN、FSGS患者中均可以发现,但以AS患者最多见。肾间质泡沫细胞的形成与尿蛋白、血脂的水平有关。肾间质泡沫细胞的存在可能与肾组织慢性化病变形成有关。
OBJECTIVE: To observe the distribution of interstitial foam cells in patients with glomerular diseases, and to analyze the relationship between them and clinical manifestations and pathological changes of renal tissues. Methods: A total of 125 cases of Alport syndrome (AS) diagnosed clinically and pathologically, 192 cases of idiopathic membranous nephropathy (IMN), 388 cases of IgA nephropathy (IgAN), focal segmental glomerulosclerosis (FSGS) 137 cases. The distribution of foam cells in renal tissue was observed, and the clinical and pathological changes in patients with or without foam cells were compared. Results: (1) The renal interstitial foam cells were present in all the four diseases of AS, IMN, IgAN and FSGS. The incidence rates were 64.8%, 21.4%, 12.4% and 36.5% respectively, of which AS was the most common. (2) The incidence and sclerosis of glomerular segmental sclerosis in renal interstitial foam cell group were significantly higher than those in control group without foam cell. The interstitial fibrosis in foam cell group was heavier in AS and IgAN patients than in control group. (3) Urine protein and lipids in renal tubulointerstitial foam cells in AS and IgAN patients were significantly higher than those in control group (P <0.01). Triglyceride levels were significantly higher in FSGS patients with renal interstitial foam cells than in controls, but there was no difference in urinary protein levels between the two groups. Conclusion: The interstitial foam cells can be found in patients with AS, IMN, IgAN and FSGS, but the most common in patients with AS. The formation of renal interstitial foam cells and urinary protein, lipid levels. The presence of interstitial foam cells may be related to the formation of chronic renal lesions.