摘要
目的:通过对肾活检标本表现为肾小球血栓性微血管病(thrombotic microangiopathy,TMA)或TMA样改变的电镜观察,分析其超微病理改变特征,为临床准确诊断TMA提供超微病理学依据.方法:回顾性分析了 560例超微结构具有TMA样改变的肾活检标本,根据肾小球毛细血管内皮细胞损伤范围和程度,分为病理特征典型的肾小球TMA样改变组和病理特征不典型的肾小球TMA样改变组;根据是否合并其它肾脏疾病,分为单纯肾小球TMA样改变组和其它肾脏疾病伴发TMA样改变组.结果:560 例标本电镜下均有不同程度的急性和/或慢性内皮损伤的超微病理改变.病理特征典型的肾小球TMA样改变 22 例(3.9%),病理特征不典型的肾小球TMA样改变538 例(96.1%).单纯肾小球TMA样改变 133 例(23.8%),其它肾脏疾病伴发TMA样改变 427 例(76.2%).结论:电镜观察可发现肾小球毛细血管内皮细胞轻微的病理变化,对于病变轻微或不典型肾小球TMA样改变及其它肾脏疾病伴发TMA样改变,电镜检查具有独特优势.
Abstract
Objective:To investigate the ultrastructural pathological characteristics of glomerular thrombotic microangiopathy(TMA)or TMA-like changes in renal biopsy specimens by electron microscopy.Methods:Retrospective analysis of 560 renal biopsy specimens with TMA-like changes by electron microscopy was performed.The biopsy specimens were classified into two groups according to the range and severity of glomerular capillary endothelium damage:typical glomerular TMA-like changes with≥50%of pathologic features of TMA and atypical glomerular TMA-like changes with less than 50%of pathologic features of TMA lesions.According to whether other glomerular diseases are combined,they are divided into pure glomerular TMA-like changes and combined TMA-like changes with other glomerular diseases.Results:A total of 560 specimens possessed varying degrees of acute and/or chronic endothelial injury under electron microscopy.22 cases(3.9%)had typical pathological features of glomerular TMA like changes,while 538 cases(96.1%)had atypical pathological features of glomerular TMA like changes.There were 133 cases(23.8%)with pure glomerular TMA like changes,and 427 cases(76.2%)with other glomerular diseases combined with TMA-like changes.Conclusions:Electron microscopy has an unique advantage in the diagnosis of TMA-like lesions,especially for mild or atypical glomerular TMA-like changes and other glomerular diseases combined with TMA-like changes.
维普
万方数据