摘要
目的分析表现有肾病综合征（NS）的非血液系统恶性肿瘤肾脏病变的临床病理特征、实验室检查特点及预后。方法回顾性分析经组织病理学确诊前后出现NS的非血液系统恶性肿瘤25例。结果男20例，女5例，年龄16—83（56．6±17．7）岁。92％的患者肿瘤和NS发生于1年之内。肿瘤分布广泛，其中消化系统和呼吸系统肿瘤占36％和20％。40％以NS为首发症状，合并血尿者为67％，12％于治疗前后合并急性肾衰竭。50％血γ球蛋白升高，28％存在与肾功能不相匹配的贫血。膜性。肾病（MN）为主要的肾脏病理改变，占67％（6／9例）。NS的预后与肿瘤的治疗直接相关，手术治疗和（或）化疗后，部分患者在糖皮质激素辅助治疗下，NS均获缓解；未对肿瘤进行处理者，5例无1例缓解。患者的预后主要与肿瘤有关，只有1例死于肾衰竭。结论恶性肿瘤可以NS为首发症状；年长的Ns患者，尤其以MN为病理表现、同时存在贫血、高1球蛋白血症者，应常规并定期作多部位肿瘤筛查。
Objective To analysis the clinical and pathological features, results of laboratory tests and prognosis of nephrotic syndrome （NS） in patients with non-heamatological malignancy. Methods The data were collected from 25 patients who presented with NS around the diagnosis of non-heamatological malignancy. Results Twenty-five cases were investigated （age： （56.6 ± 17.7） years; male/female ratio： 20/5）. Malignancy and NS occurred within one year in 92% patients. There was a wide distribution of malignancy with involvement of 36% in digestive system and 20% in respiratory system. Ten patients （40%） presented with NS as their initial manifestation. Heamaturia appeared in 67% patients and acute renal insufficiency was complicated in 12% cases before treatments. Some other non-specific laboratory tests were found including elevated serum gamma-globulin in 50% and anemia not related with renal failure in 28% cases. Membranous nephropathy was the most common pathological changes in 67% cases. Although NS still continued for several weeks in 8 of 9 cases after surgery and/or chemical therapy, glucoeorticoids was helpful to achieve the remission in these patients. However, no remission was achieved in patients without the treatment for malignancy. Conclusion Malignancy may present with NS as its initial manifestation. It should be inspected routinely and regularly in elder patients with NS, especially in those with membranous nephropathy, as well as gamma-globulinemia and anemia.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2008年第11期897-900,共4页
Chinese Journal of Internal Medicine
关键词
肾病综合征
肿瘤
肾小球肾炎
膜性
Nephrotic syndrome
Neoplasm
Glomerulonephritis, membranous
