【摘要】 目的:探讨不同剂型、不同剂量马兜铃酸药物导致马兜铃酸肾病的临床病理特点。方法:31例马兜铃酸肾病患者分为汤药组21例和成药组10例。汤药组根据所含关木通剂量分为小剂量组7例和大剂量组14例。观察不同剂量服药后首发症状,肾功能及肾组织活检病理改变。结果:成药组以贫血(40%)、乏力(30%)为首发症状,表现为慢性肾功能衰竭(90%)。病理改变呈慢性间质小管病变,但"寡"炎细胞浸润。大剂量组以恶心、呕吐、食欲不振为首发症状(71%),表现为急性肾功能衰竭(57%),糖尿和氨基酸尿阳性率分别为100%和75%。病理改变表现为急性肾小管坏死。小剂量组视服药时间长短,可表现为急性或慢性肾功能衰竭,病理改变为早期慢性间质性肾炎。成药组及小剂量组表现为慢性肾功能衰竭者尿糖(分别为42.8%和50.0%)、尿氨基酸(分别为28.8%和50.0%)升高比例<大剂量组。结论:不同剂型、不同剂量马兜铃酸药物所致马兜铃酸肾病,可表现为急性或慢性肾功能衰竭。病理改变以急性肾小管坏死或慢性间质小管病变,"寡"炎细胞浸润为特点。更多还原

【Abstract】 Objective To study the clinical and histological features in aristolochic acid nephropathy caused by different drug type and different dosage of Mutong.Methods Thirty-one patients with aristolochic acid nephropathy were divided into 3 groups based on the dose and drug type of Mutong: group A(Mutong in decoction,10 g/d in,n=14),group B(Mutong in decoction,3 to 9 g/d,n=7) and group C(Mutong patent drug,n=10).The duration of Mutong administration,initial symptoms,laboratory examination results and renal biopsy histological changes were compared respectively.Results Group A had initial symptoms of severe gastrointestinal symptoms(71%) and acute renal failure(57%),with the positive rates of glucosuria and aminoaciduria of 100% and 75%.Renal biopsy showed acute tubular necrosis.Group C had initial symptoms of anemia(40%) and fatigue(30%),and 90% patients had chronic renal failure.Severe acellular tubuilointerstitial fibrosis with marked glomerular ischemia and arterial narrowing were found in group C.The patients in group B had acute renal failure or chronic renal failure with a different duration of Mutong administration.Renal biopsy showed early and moderate chronic tubuilointerstitial fibrosis.The patients with chronic renal failure in group B and group C had lower rates of glucosuria(50.0%,42.8% respectively) and aminoaciduria(50.0%,28.8% respectively) than those in group A.Conclusion Aristolochic acid nephropathy caused by various drug types and dosage of aristolochic acid could be presented acute or chronic renal failure.Renal biopsy histological changes have the features of acute tubular necrosis or chronic acellular tubuilointerstitial fibrosis.更多还原