胸腺瘤相关性肾小球病12例临床及病理特点分析-中华肾脏病杂志.PDF

中华肾脏病杂志2018 年8 月第34 卷第8 期 Chin J Nephrol, August 2018, Vol. 34, No.8 ·587 · ·临床研究 · 胸腺瘤相关性肾小球病12例临床及 病理特点分析 郑茜子 高碧霞 喻小娟 王素霞 周福德 【摘要】 目的 了解胸腺瘤相关性肾小球病患者的临床病理改变特点。方法 回顾性 分析北京大学第一医院2008 年10 月至2017 年6 月诊断为胸腺瘤相关性肾小球病患者的临床 及病理资料，包括胸腺瘤的组织学分型及分期、肾小球病的临床表现、病理改变特点及治疗效 果。结果 共12 例患者入选，年龄（55± 16）岁，男∶女=3 ∶1。胸腺瘤组织学分型以B2 型最常 见，9 例合并重症肌无力。8 例患者肾病发生时伴有胸腺瘤活动，11 例患者临床表现为肾病综 合征，10 例合并急性肾损伤。11 例患者接受了肾组织活检，其中微小病变肾病5 例，膜性肾病 3 例，局灶节段性肾小球硬化、血栓性微血管病及毛细血管内增生性肾小球肾炎各1 例。11 例 患者接受了免疫抑制药物治疗，中位随访时间为12 个月，其中7 例患者免疫抑制剂治疗后尿 蛋白量减少，6 例急性肾损伤患者肾功能部分或完全缓解。结论 胸腺瘤相关性肾小球病以 微小病变肾病最常见，常与重症肌无力合并存在。对有手术、放化疗禁忌证或抗肿瘤治疗后 肾病不缓解者，可考虑以糖皮质激素为一线药物的免疫抑制剂治疗胸腺瘤相关性肾小球病。 【关键词】 胸腺瘤； 肾病； 类肿瘤综合征 Clinicopathological analysis of 12 cases of thymoma ⁃associated glomerulonephropathy Zheng Xizi,GaoBixia,YuXiaojuan,WangSuxia,ZhouFude. DepartmentofNephrology,theFirstHospital, Institute of Nephrology, Peking University, Key Lab of Renal Disease, Ministry of Health of China, Beijing 100034,China Correspondingauthor:ZhouFude,Email:zhoufude1801@ 【Abstract 】 Objective To elucidate the clinical and pathological characteristics of the patients with thymoma ⁃associated glomerulonephropathy. Methods In this retrospective study, the clinicopathologic characteristics of patients diagnosed as thymoma ⁃associated glomerulonephropathy in Peking University First Hospital during the period between Oct 2008 and Jun 2017 were analyzed, including the histological classfication of thymoma, the clinicopathological features and the short-term prognosis. Results Altogether twelve patients were included with an average age of (55 ± 16) years; male/female ratio was 3 ∶1. The B2 type thymoma was the most common type. Nine cases also suffered from myasthenia gravis, and eight cases of glomerulopathy accompanied by thymoma activity