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1、·322·《临床荟萃》2007年3月5日第22卷第5期ClinicalFocus,March5,2007,Vol22,No.5·论著·肥胖相关性肾病临床和病理特点分析1a1b1a22曹树臣,房铭辉,卜春红,房艳辉,刘志红(1承德医学院附属医院a.ICU;b.神经内科,河北承德067000;2.南京军区总医院肾脏病研究所,江苏南京210002)摘要:目的分析总结肥胖相关性肾病(obesityrelatedglomerulopathy,ORG)临床表现、肾活检组织学改变和超微结构特征。方法回顾性分析
2、41例ORG患者,32例患者行胰岛功能检查,根据患者是否合并胰岛素抵抗(IR)分为两组,组Ⅰ:存在胰岛素抵抗;组Ⅱ:无胰岛素抵抗。根据肾活检组织学改变分为肥胖相关性单纯性肾小球肥大(obisity2relatedglomerulomegaly,O2GM)和肥胖相关性局灶节段性肾小球硬化(obisity2relatedfocalandsegmentalglomerulosclerosis,O2FSGS)。分别比较临床和病理组织形态学特点。结果组Ⅰ和组Ⅱ患者比较,组Ⅰ患者游离胰岛素、游离胰岛素/空腹
3、血糖、HOMA2IR较组Ⅲ明显升高,差异具有统计学意义(P<0.05)。病理上,O2FSGS占65.85%(27/41例),O2GM占34.15%(14/41)。结论ORG患者胰岛素抵抗常见,脂肪肝发生率高,组织形态学改变以O2FSGS最常见,其次是O2GM。关键词:肥胖;肥胖相关性肾病;蛋白尿;肾小球肥大;肾小球硬化;超微结构中图分类号:R692文献标识码:A文章编号: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等报告约40%的肥胖患者可以其他可能导致局灶节段性硬化
