Page 59 - 中国全科医学2022-08

·952· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

·论著·

白血病肾损害患者的临床病理特征研究

王伊娜，董葆，李欣，邵春影，左力，王梅，燕宇 * 扫描二维码
查看原文

【摘要】 背景 肾脏是白血病患者重要的髓外受累器官，但目前关于白血病肾损害的病例报道很少，临床医师
对其认识不足。目的 分析白血病肾损害的临床病理特征。方法 选取 2010 年 6 月至 2020 年 6 月北京大学人民医院
收治的白血病肾损害患者 5 例为研究对象，回顾性分析其一般资料、临床表现、超声和实验室检查结果、肾组织活检
及病理检查结果、治疗方案及随访情况。结果 5 例白血病肾损害患者均为男性，发病年龄为 19~73 岁；2 例为急性
淋巴细胞白血病（B 细胞型）、异基因造血干细胞移植术后，其余 3 例为慢性淋巴细胞白血病（B 细胞型）；患者均
出现急性肾损伤，合并蛋白尿；肾脏病理主要表现为急性间质性肾炎，其中 2 例合并肾小球疾病；经病理检查证实 2
例急性淋巴细胞白血病（B 细胞型）患者出现肾脏髓外复发，3 例慢性淋巴细胞白血病（B 细胞型）患者病情进展。4
例患者接受规律化疗，其中 2 例出现血肌酐下降，2 例肾功能无改善。结论 白血病肾损害患者常见临床表现为急性
肾损伤，主要病理表现为急性间质性肾炎，并可继发肾小球疾病；及时完善肾组织活检及病理检查，特别是针对肾间
质浸润细胞进行免疫组化染色有助于明确诊断并指导临床合理治疗。
【关键词】 白血病；急性肾损伤；活组织检查；疾病特征
【中图分类号】 R 733.7 R 692.5 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2021.01.504
王伊娜，董葆，李欣，等 . 白血病肾损害患者的临床病理特征研究［J］. 中国全科医学，2022，25（8）：952-
956，962. ［www.chinagp.net］
WANG Y N，DONG B，LI X，et al. Clinicopathological manifestations of kidney injury in leukemia［J］. Chinese General
Practice，2022，25（8）：952-956，962.

Clinicopathological Manifestations of Kidney Injury in Leukemia WANG Yina，DONG Bao，LI Xin，SHAO Chunying，
ZUO Li，WANG Mei，YAN Yu *
Department of Nephrology，Peking University People's Hospital，Beijing 100044，China
*
Corresponding author：YAN Yu，Associate chief physician；E-mail：yanyu@bjmu.edu.cn
【Abstract】 Background Kidney is a major extramedullary organ involved in leukemia，but clinicians have
insufficient understanding of it due to rare case reports. Objective To analyze the clinicopathological manifestations of kidney
injury in leukemia. Methods Five patients with kidney injury in leukemia were recruited from Peking University People's
Hospital from June 2010 to June 2020. Their demographics，clinical manifestations，ultrasonic and laboratory examination
results，pathological examination results of renal biopsy species，therapeutic regimen and follow-up were retrospectively
analyzed. Results All these patients were male，with an onset age ranging from 19 to 73 years old. Two of them had B-cell
acute lymphoblastic leukemia after allogeneic stem cell transplantation，the remaining three had B-cell chronic lymphocytic
leukemia. All of them had acute kidney injury with proteinuria，and pathologically manifestation of acute interstitial nephritis.
In addition，two of them also had leukemia-related glomerular disease. Renal pathology indicated extramedullary recurrence in
the two cases of B-cell acute lymphoblastic leukemia，and progression in the other three cases of B-cell chronic lymphoblastic
leukemia. Four patients received regular chemotherapy，and two of them obtained a reduction in serum creatinine levels，but the
other two showed no improvement in renal function. Conclusion Kidney injury in leukemia commonly manifests as acute kidney
injury clinically，acute interstitial nephritis pathologically，and may be complicated by secondary glomerulopathy. Prompt renal
biopsy，especially immunohistochemical staining for renal interstitial infiltrating cells，may be helpful for accurate diagnosis and
appropriate treatment guidance.
【Key words】 Leukemia；Acute kidney injury；Biopsy；Disease attributes

基金项目：国家自然科学基金青年科学基金项目（81000296）；教育部博士点基金新教师项目（20090001120098）；北京大学
人民医院研究与发展基金资助项目（RD-2013-15）
100044 北京市，北京大学人民医院肾内科
*
通信作者：燕宇，副主任医师；E-mail：yanyu@bjmu.edu.cn
本文数字出版日期：2022-01-27