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1、·322·《臨床薈萃》2007年3月5日第22卷第5期ClinicalFocus,March5,2007,Vol22,No.5·論著·肥胖相關性腎病臨床和病理特點分析1a1b1a22曹樹臣,房銘輝,卜春紅,房艷輝,劉志紅(1承德醫(yī)學院附屬醫(yī)院a.ICU;b.神經內科,河北承德067000;2.南京軍區(qū)總醫(yī)院腎臟病研究所,江蘇南京210002)摘要:目的分析總結肥胖相關性腎病(obesityrelatedglomerulopathy,ORG)臨床表現、腎活檢組織學改變和超微結構特征。方法回顧性分析
2、41例ORG患者,32例患者行胰島功能檢查,根據患者是否合并胰島素抵抗(IR)分為兩組,組Ⅰ:存在胰島素抵抗;組Ⅱ:無胰島素抵抗。根據腎活檢組織學改變分為肥胖相關性單純性腎小球肥大(obisity2relatedglomerulomegaly,O2GM)和肥胖相關性局灶節(jié)段性腎小球硬化(obisity2relatedfocalandsegmentalglomerulosclerosis,O2FSGS)。分別比較臨床和病理組織形態(tài)學特點。結果組Ⅰ和組Ⅱ患者比較,組Ⅰ患者游離胰島素、游離胰島素/空腹
3、血糖、HOMA2IR較組Ⅲ明顯升高,差異具有統(tǒng)計學意義(P<0.05)。病理上,O2FSGS占65.85%(27/41例),O2GM占34.15%(14/41)。結論ORG患者胰島素抵抗常見,脂肪肝發(fā)生率高,組織形態(tài)學改變以O2FSGS最常見,其次是O2GM。關鍵詞:肥胖;肥胖相關性腎病;蛋白尿;腎小球肥大;腎小球硬化;超微結構中圖分類號:R692文獻標識碼:A文章編號:10042583X(2007)0520322205Analysisofclinical,histologicalandultr
4、astructuralcharacteristicsofobesityrelatedglomerulopathypatients3CAOShu2chen,FANGMing2hui,BUChun2hong,FANGYan2hui,LIUZhi2hong3DepartmentofIntensiveCareUnit,theHospitalofChengdeMedicalCollege,Chengde067000,ChinaABSTRACT:ObjectiveToinvestigatetheclinic
5、al,histologicalandultrastructuralfeaturesofobesityrelatedglomerulopathy(ORG).MethodsRetrospectiveanolysiswasconductedon41ORGpatients,32patientshadbeentestedforpancreaticfunction.Twogroupsweredividedasfollows,groupⅠ:insulinresistance;groupⅡ:withoutins
6、ulinresistance.Fromneedlepathology,thepatientsweredividedintoobesity2relatedfocalandsegmentalglomerulosclerosis(O2FSGS)andobesity2relatedglomerulomegaly(O2GM)group.Theirclinicalandlaboratoryfeatureswerescomparedrespectively.ResultsBetweenthetwogroups
7、,therewerecompareddifferensesinfreeinsulin,freeinsulin/fastingbloodsugar,HomeostaticModelAssessmen2insulinresistance.Frompathologyexamination,65.85%patientsbelongedtoO2FSGS,and34.15%patientsbelongedtoO2GM.ConclusionORGpaientsoftencomplicatewithinsuli
8、nresistance.ThemorbilityoffattyliverwashighinORGpatients.O2FSGSwasthemostcommonpathologicaltype,thenO2GM.KEYWORDS:obesity;obesityrelatedglomerulopathy;proteinuria;glomerulomegaly;glomerulosclerosis;ultrastructure1923年Preble等報告約40%的肥胖患者可以其他可能導致局灶節(jié)段性硬化
