妊娠诱发肾损害的临床特征与病理类型的相关性
| 作者: |
1方利,
1张军,
1潘乾广,
1常欢,
1张倩,
2孙珊珊,
1赵洪雯,
1申兵冰
1 陆军军医大学第一附属医院肾科，重庆 400038 2 陆军军医大学第一附属医院病理科，重庆 400038 |
| 通讯: |
赵洪雯
Email: sbbiceme1234@sina.com 申兵冰 Email: sbbiceme1234@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.11.018 |
| 基金: | 重庆市科卫联合医学研究项目(2018MSXM123)。 |
摘要
目的：探讨妊娠诱发肾损害的临床特征与病理类型的相关性。方法：回顾性分析陆军军医大学第一附属医院2013年3月至2018年3月肾科住院的孕前未发现任何肾脏损害的相关表现，孕期出现水肿、高血压、蛋白尿等同时病理学证实存在肾脏损害的患者，搜集其孕期及产后24 h尿蛋白定量、白蛋白、肌酐、血脂、血常规、病理诊断、血压等指标。结果：最终48例患者纳入本研究，妊娠孕周8~40+6周，妊娠期肾病综合征(nephrotic syndrome of pregnancy，NSP)18例(37.5%)，胎儿存活率为76%，存活胎儿中早产19例(50%)，低体重儿21例(55.2%)，剖宫产33例(86.8%)。根据产后1年估算的肾小球滤过率(estimated glomerular filtration rate，eGFR)是否正常，分为异常组17例及正常组31例，异常组孕期首次eGFR为65.93 mL/min/1.73 m2，低于正常组112.31 mL/min/1.73 m2(P=0.001)，异常组血红蛋白较正常组低、白细胞较正常组高(P分别为0.003，0.025)；产后首次指标中，异常组中eGFR为49.32 mL/min/1.73 m2低于正常组110.04 mL/min/1.73 m2(P<0.001)。产后肾脏穿刺活检病理，其中局灶节段肾小球硬化15例(31.25%)，IgA肾病10例(20.84%)，系膜增生性肾小球肾炎9例(18.75%)，狼疮性肾炎8例(16.68%)。结论：妊娠诱发肾损害的主要病理类型为局灶节段肾小球硬化；首发表现为肾功能损伤的患者，或者产后早期复查肾功能未能快速恢复的，其病理损害较重，应当及时肾活检，改善肾功能预后。
关键词：
妊娠；肾损害；肾活检；病理
Correlation between clinical features and pathological types of renal injury induced by pregnancy
CorrespondingAuthor: ZHAO Hongwen Email: sbbiceme1234@sina.com
DOI: 10.3978/j.issn.2095-6959.2021.11.018
Foundation: This work was supported by the Chongqing Kewei Joint Medical Research Project, China (2018MSXM123).
Abstract
Objective: To explore the correlation between clinical features and pathological types of renal injury induced by pregnancy. Methods: Retrospective analysis was performed on the patients who hospitalized in our department from March 2013 to March 2018 without any pre-pregnancy manifestations of kidney damage, but with edema, hypertension, proteinuria and kidney damage confirmed by pathology during pregnancy. The pregnancy and postnatal 24-h urine protein, albumin, creatinine, blood lipid, blood routine, pathological diagnosis and blood pressure were collected. Results: Forty-eight patients were included in the study, and the gestation period was 8–40+6 weeks. There were 18 cases (37.5%) of nephrotic syndrome of pregnancy, and the fetal survival rate was 76%. Among the surviving fetuses, 19 cases (50%) were preterm birth, 21 cases (55.2%) were low birth weight infants, and 33 cases (86.8%) were cesarean section. According to the estimated glomerular filtration rate (eGFR) at 1 year postpartum, 17 patients were divided into abnormal group and 31 patients were normal group. The eGFR of the abnormal group was 65.93 mL/min/1.73 m2 at the first time of pregnancy, which was lower than that of the normal group 112.31 mL/min/1.73 m2 (P=0.001). The hemoglobin of the abnormal group was lower than that of the normal group, and the white blood cells were higher than that of the normal group (P=0.003, 0.025, respectively). For the first postnatal indicator, eGFR in the abnormal group was 49.32 mL/min/1.73 m2, which was lower than that of the normal group 110.04 mL/min/1.73 m2 (P<0.001). Postpartum renal biopsies revealed 15 cases of focal segmental glomerulosclerosis (31.25%), 10 cases of IgA nephropathy (20.84%), 9 cases of mesangial proliferative glomerulonephritis (18.75%) and 8 cases of lupus nephritis (16.68%). Conclusion: The main pathological type of pregnancy-induced renal damage is focal segmental glomerulosclerosis. Patients with the first manifestation of renal function injury, or the renal function that fails to recover quickly after early postpartum review, have serious pathological damage, and renal biopsy should be conducted in time to improve the prognosis of renal function.
Keywords：
pregnancy; kidney damage; renal biopsy; pathology