孤立性C3沉积系膜增生性肾小球肾炎50例临床剖析.docVIP

孤立性C3沉积系膜增生性肾小球肾炎50例临床剖析 　　[摘要] 目的 探?孤立性C3沉积系膜增生性肾小球肾炎患者的临床特点和诊治情况。 方法 选取我院2012年1月～2015年2月期间入院的50例孤立性C3沉积系膜增生性肾小球肾炎患者作为研究对象，分析患者血尿、高血压、血清BUN、Cr、补体C3、免疫球蛋白、24 h尿蛋白定量等指标检查结果，并探讨其治疗情况。 结果 喷嚏、鼻塞、清水样鼻涕、咳嗽、咽干或灼热感是孤立性C3沉积系膜增生性肾小球肾炎的主要临床表现；进展症状为无症状性的血尿、蛋白尿、慢性肾小球肾炎等。镜检可见肾小球源性血尿，且尿中红细胞呈多变性改变；尿中可出现C3和α2巨球蛋白等大分子蛋白；B超检查早期肾脏大小正常，晚期双侧对称性缩小，皮质变薄；光镜检查显示弥漫性增生，可伴有系膜区的增宽，肾小管间质慢性病变，管腔内有少量蛋白管型，小叶间动脉内膜增厚。大部分患者采用抗感染、利尿、降压和抗凝等治疗后病情均得到有效控制。 结论 导致孤立性C3沉积系膜增生性肾小球肾炎的原因较多，且其发病初期无典型临床表现，为了降低漏诊率，临床需结合多种检查予以确诊，并及时对患者采取有效治疗措施，可显著提高治疗效果。 　　[关键词] 增生性肾小球肾炎；临床特点；光镜；预后 　　[中图分类号] R692.3+1 [文献标识码] B [文章编号] 1673-9701（2016）36-0041-03 　　[Abstract] Objective To investigate the clinical characteristics， diagnosis and treatment of isolated C3 mesangial proliferative glomerulonephritis. Methods 50 patients with isolated C3 mesangial proliferative glomerulonephritis（CM） in our hospital from January 2012 to February 2015 were studied. Test results of indicators including hematuria， hypertension， serum BUN， Cr， complement C3， immunoglobulin， 24h urinary protein quantification of patients were analyzed. Results Sneezing， stuffy nose， watery nose， cough， throat or burning sensation were the main clinical manifestations of isolated C3 mesangial proliferative glomerulonephritis；and progressive symptoms included asymptomatic hematuria， proteinuria， chronic glomerular nephritis. Microscopic examination showed glomerular hematuria and urinary erythrocytes with irregular shape changes. And macromolecular proteins including C3 and α2 macroglobulin could be seen. B-ultrasound examination showed normal kidney size at early stage， and bilateral symmetry narrow and cortical thinning at the late stage.Optical microscopy showed diffuse hyperplasia，may associated with mesangial area widening， and renal tubular interstitial chronic lesions， with a small amount of protein tube type in it and interlobular artery intima thickening. Conditions of most patients were effectively controlled after being treated with anti-infective， diu