伴新月体形成的原发性肾小球肾炎的临床及病理特征分析

唐军龙　唐盛　覃建宏　刘芸芳

肾内科，南宁530021；3.广西南宁市第三人民医院内科，南宁 530003）

【摘要】目的探讨伴新月体形成的原发性肾小球肾炎的临床及病理特点。方法回顾性分析2007年1月至2013年6月期间310例肾脏疾病患者，其中伴新月体形成的原发性肾小球肾炎92例。将92例病例按新月体形成累及肾小球的比例分为A组（累及肾小球比例>10%，50例）和B组（累及肾小球比例≤10%，42例）；比较患者的临床症状、病理类型。结果确诊原发性肾小球肾炎伴新月体形成92例，均存在不同程度的血尿、蛋白尿，血尿以镜下血尿为主（89.1%），肉眼血尿占10.9%，蛋白尿>1 g/d占58.7%；26.1%患者血肌酐>133 μmol/L，65.2%患者伴有高血压；54.3%患者新月体形成累及肾小球比例>10%；IgA肾病82例（89.1%），膜性肾病5例（5.4%），2型新月体性肾炎2例（2.4%），膜增生肾小球肾炎2例（2.4%），局灶增生性肾小球肾炎1例（1.2%）；82例IgA肾病患者中，以局灶增生性IgA肾病（58.7%）为主；两组高血压比例差异无统计学意义（P>0.05），A组血肌酐>133 μmol/L、蛋白尿>1 g/d、血尿>30个/高倍镜的比例均高于B组，差异有统计学意义（P<0.05）；A组血肌酐、蛋白尿水平及血尿红细胞数均高于B组，差异有统计学意义（P<0.01）。结论伴新月体形成的原发性肾小球肾炎其病理类型以IgA肾病多见，临床症状以血尿、蛋白尿、高血压为主；新月体形成累及肾小球的比例对机体的临床症状、病情及预后均有一定的影响。

【关键词】肾小球肾炎；新月体；临床症状；病理类型

中图分类号：R692.3+1 文献标识码：ADOI：10.3969/j.issn.10031383.2015.03.009

Analysis of clinical and pathological features of primary

glomerulonephritis with crescent formation

TANG Junlong1，TANG Sheng2，QIN Jianhong3，LIU Yunfang2

（1.Urology Department，Lingshan Peoples Hospital，Lingshan 535400；2.Nephrology Department，Peoples

Hospital of Guangxi Zhuang Autonomous Region，Nanning 530021；3.Department of Internal Medicine，

The Third Peoples Hospital of Nanning，Nanning 530003，Guangxi，China）

【Abstract】ObjectiveTo investigate clinical and pathological features of primary glomerulonephritis with crescent formation.Methods310 cases of renal disease patients during the period of January，2007 to June，2013 were retrospectively analyzed. Among all of the above-mentioned patients，there were 92 cases of primary glomerulonephritis with crescent formation.The 92 patients were selected to the study and divided into group A （ratio of glomeruli involvement>10%，50 cases） and group B （ratio of glomeruli involvement≤10%，42 cases） in accordance with ratio of glomeruli involvement in crescent formation.Then，clinical symptoms and pathological types were compared between groups.Results 92 cases were confirmed with primary glomerulonephritis with crescent formation，and all of them had varying degrees of hematuria and proteinuria.Microscopic hematuria accounted for the main percentage（89.1%） of hematuria，gross hematuria accounted for 10.9%，and proteinuria>1g/d accounted for 58.7%.26.1% of patients with serum creatinine>133μmol/L，and 65.2% of patients were complicated with hypertension，54.3% of patients with ratio of glomeruli involvement in crescent formation>10%.Of all the patients，82 cases got IgA nephropathy（89.1%），5 cases got membranous nephropathy（5.4%），2 cases got type 2 crescentic glomerulonephritis（2.4%），2 cases got membrane proliferation glomerulonephritis （2.4%），and 1 case got focal proliferative glomerulonephritis（1.2%）.Of all IgA nephropathy patients，patients with focal proliferative IgA nephropathy accounted for the main percentage （58.7%）.Difference of percentage of hypertension patients in both groups was not statistically significant（P>0.05）.Percentages of serum creatinine>133 μmol/L，proteinuria>1g/d，and hematuria>30/high power lens in the group A were obviously higher than that of the group B，so difference was statistically significant（P<0.05）.Levels of serum creatinine and proteinuria as well as red blood cell count of hematuria in the group A were significantly higher than those of the group B，so difference was statistically significant（P<0.01）.ConclusionIgA nephropathy is the mian pathological type of primary glomerulonephritis with crescent formation，hematuria，proteinuria and hypertension are the main clinical symptoms.Ratio of glomeruli involvement in crescent formation has certain influence on clinical symptoms，body condition and prognosis of the patients.endprint

【Key words】glomerulonephritis；crescent；clinical symptoms；pathological types

慢性肾功能不全为慢性进展性肾脏疾病，发病率达10%左右，且有逐年增高的趋势，严重危及患者生命健康，给社会及家庭带来沉重负担[1]。遗传、免疫因素、环境因素等多种因素可引起慢性肾功能不全，而我国的慢性肾小球肾炎为慢性肾功能不全的最常见病因[2]。如肾小球肾炎患者伴有新月体形成，常预示预后不良[3]。本研究通过对我院原发性肾小球肾炎伴新月体形成的临床病例资料进行分析，旨在为相关疾病的诊治提供一定的依据。