肾小球血栓性微血管病样改变的超微病理观察
孙小玲，张芳成，刘 乐，肖 艺，聂星星，官 阳*肾小球血栓性微血管病样改变的超微病理观察
孙小玲，张芳成，刘 乐，肖 艺，聂星星，官 阳*
（武汉大学人民医院超微病理中心，湖北 武汉 430060）
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。
关键词 肾活检；TMA ; 电镜；超微病理
中图分类号：R543.7；R447；R365 文献标识码：A doi:10.3969/j.issn.1000-6281.2024.02.008
Ultrastructural pathological observation of glomerular thrombotic microangiopathy-like changeson renal biopsies
SUN Xiaoling, ZHANG Fangcheng, LIU Le, XIAO Yi, NIE Xingxing, GUAN Yang *
(Center of ultrastructural pathology, People's Hospital of Wuhan University, Wuhan Hubei 430060, China)
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.Conclusion: 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.
Keywords renal biopsy；thrombotic microangiopathy；electron microscopy；ultrastructural pathology
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