塌陷性肾小球病 2

WT1和Pax-2蛋白。正常生理情况下，WT1蛋白存在于肾单位形成期及成年肾脏的足突细胞核中，Pax-2仅在肾小囊上皮细胞核中。CG患者足突细胞核内WT1减少，而胞浆中增多，少数病人肾小球上皮细胞核中有异常的Pax2表达。Meyrier等人［10］则提出在CG中足突细胞与肾小球基底膜分离，脱落至包曼氏囊腔，积聚在肾小管腔内，转变成巨噬细胞样细胞，与严重的小管间质病变相关。有学者发现1例α-干扰素治疗的丙型肝炎患者发生CG，停药后重新肾活检证实肾脏病变恢复为FSGS［11］。还有人在CG患者标本中用PCR方法检测到细小病毒B19(PV19)较FSGS多［12］。上述研究结果显示CG肾活检发病机理已引起广泛重视，但要明确阐述其发病机理，尚需更多更深入的研究。

　　综上所述，塌陷性肾小球病是新的病理概念，有独特的病理特点，预后差，它已经为越来越多的肾脏病理学家所重视。

　　作者单位：100034　北京医科大学第一医院肾内科

参考文献

　　1　Thomas E,Pardo V，Perez G.Collapsing glomerulopathy among cases of focal segmental glomerulosclerosis.review of the last 20years.JASN,1997,8:545A(abstract).

　　2　Maricarmen AC,Tommaso BR,Norma UU,et al.Collapsing glomerulopathy:10 years retrospective histological review.JASN,1997,8:92A(abstract).

　　3　Crary GS,Gulache HE,Crosson JT.Collapsing glomerulopathy:a five-year retrospective histologic and lmmunohistochemical study.JASN,1996,7:1771(abstract).

　　4　Weiss MA,Daquioag E,Margolin EG,et al.Nephrotic syndrome,progressive renal failure,and glomerular “collapse”:a new clinicopathologic entity?Am J Kidney Dis，1986,7:20-28.

　　5　Detwiler RK,Falk RJ,Hogan SI,et al.Collapsing glomerulopathy:a clinically and pathologically distincl variant of focal segmental glomerulosclcrosis.Kidney Int,1994,45:1416-1424.

　　6　Detwiler RK,Hogan SL,Falk RJ,et al.Collapsing glomerulopathy in renal transplant patients:rccurrence and de novo occurrence.JASN,1996,8:1331(abstract).

　　7　Bourgoingnie JJ,Meneses R,Pardo V.The nephropathy related to acquired immune deficiency syndrome.Adv Nephrol,1988,17:113-124.

　　8　Agati VD,Suh JI,Carbone L,et al.Pathology of HIV-associated nephropathy:a detailed morphologic and comparative study.Kidney Int,1989,35:1358-1370.

　　9　Yang Y,Beaufils H,Gubler MC.Expression of WT1 and Pax-2 in idiopathic collapsing glomerulopathy and HIV-Associated nephropathy.JASN 1997,8:546A(abstract).

　　10　Bariety J,Nochy D,Mandet C,et al.Podocytes undergo phenotypic changes and express macrophagic-associated markers in idiopathic callapsing glomerulopathy.Kidney Int,1998,53:918-925.

　　11　Meeus F,Kourilsky O,Boulesteix S,et al.Collapsing glomerulopathy occurring in a patient treated by γ-interferon for an HCV epatitis.JASN,1997,8:128A(abstract).

　　12　Moudgil A,Bagga A,Nast CC,et al.Detection of parvovirus B19 DNA in renal biopsies of patients with idiopathic collapsing glomerulopathy.JASN 1997,8:94A(abstract).