【摘要】 目的观测成人微小病变肾病(MCD)患者在肾病期、部分缓解期、完全缓解后足细胞超微结构的改变,分析其与蛋白尿程度的相关性。方法 2007年1月至2009年6月在北京大学第一医院肾穿刺及外院送检标本确诊为MCD的患者29例,其中肾病期10例、部分缓解期13例、完全缓解后6例,以6例肾肿瘤切除术后患者的正常肾组织作为对照。在透射电镜下观测足突平均宽度、每10μm肾小球基底膜(GBM)上足突个数、足突融合的对应GBM的百分比以及高度与宽度比值分别≥0.5、1.0的"脊"的个数和形态。结果 MCD患者在病变的不同时期均有不同程度的足突融合。无论是在肾病期,还是在部分缓解期和完全缓解后足突平均宽度、每10μmGBM足突个数、足突融合的GBM百分比均比正常对照组高(P<0.05);足突平均宽度和足突融合的GBM百分比与蛋白尿程度呈正相关(r=0.65、r=0.69,P<0.001),单位GBM上的足突数与蛋白尿程度呈负相关(r=-0.52,P<0.001);每10μmGBM"脊"数,随蛋白尿减少而增加:当"脊"高度定义为≥0.5时,完全缓解组与正常对照组无统计学差异(P>0.05);当"脊"高度定义为≥1.0时,完全缓解组仍少于正常对照组(P<0.05)。结论 MCD患者中,随着尿蛋白量的减少,足突宽度变窄、足突融合对应的GBM比例下降、足突数量增多。蛋白尿转阴在前,足突恢复在后。随着恢复程度的增加,"脊"的高度也在增加。更多还原

【Abstract】 Objective To observe the ultrastructure changes of the podocyte foot processes and to analyze their relationship with the degree of the proteinuria in patients with minimal change disease (MCD) in remission phase.Methods Twenty-nine patients with MCD,including 10 patients with nephrotic syndrome,13 patients with partial remission and 6 patients with complete remission,were recruited.Their width foot process,extent of foot process effacement,and number of foot processes on 10 μm of glomerular basement membrane (GBM) were measured under transmission electron microscope.The "ridge" was defined as the ratio of its height to basal width≥0.5 or 1.0.Normal renal tissues from 6 nephrectomies of renal carcinoma were taken as controls.Results There were various foot process effacements in patients in different phases of MCD.All their width of foot process,extent of the foot process effacement and number of foot processes on 10 μm of GBM were more than normal group (P<0.05).Foot process width and the percentage of capillary loops affected by foot process effacement was positively correlated with the degree of proteinuria (r=0.68,r=0.73,P<0.05).With remission,the number of "ridge" increased.When "ridge" was defined as the ratio of its height to basal width≥0.5,there was no statistical difference between complete remission group and normal group (P>0.05).However,when it was defined as≥1.0,normal group was still more than complete remission group (P<0.05).Conclusions In patients with MCD,with proteinuria reducing,both foot process width and the percentage of capillary loops affected by foot process effacement decrease and the number of the foot processes increase.When these patients are in complete remission,their foot processes of podocytes have not been back to completely normal.With the remission,the height of the "ridge"is also increased.更多还原