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中华肾病研究电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 176 -179. doi: 10.3877/cma.j.issn.2095-3216.2023.03.011

病例报告

THSD7A相关性膜性肾病:一例报告及文献复习
张叶, 王兴华, 高玉伟, 胡秀红, 崔红蕊, 徐保振, 杨洪娟, 王涛()   
  1. 050011 石家庄,河北医科大学研究生学院
    050030 石家庄,河北医科大学第一医院肾脏内科
  • 收稿日期:2023-03-28 出版日期:2023-06-28
  • 通信作者: 王涛
  • 基金资助:
    河北省中医药管理局科研项目(2020163)

THSD7A-associated membranous nephropathy: a case report and literature review

Ye Zhang, Xinghua Wang, Yuwei Gao   

  • Received:2023-03-28 Published:2023-06-28
引用本文:

张叶, 王兴华, 高玉伟, 胡秀红, 崔红蕊, 徐保振, 杨洪娟, 王涛. THSD7A相关性膜性肾病:一例报告及文献复习[J]. 中华肾病研究电子杂志, 2023, 12(03): 176-179.

Ye Zhang, Xinghua Wang, Yuwei Gao. THSD7A-associated membranous nephropathy: a case report and literature review[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(03): 176-179.

膜性肾病(membranous nephropathy,MN)是成人肾病综合征(nephrotic syndrome,NS)的主要原因,约80%的MN没有明确的继发性病因,称为特发性膜性肾病(idiopathic membranous nephropathy,IMN),病理特征为肾小球基底膜增厚、上皮下免疫复合物沉积。约20%的MN病例继发于自身免疫性疾病、感染、恶性肿瘤、药物和重金属中毒等,称为继发性膜性肾病。1型血小板反应蛋白7A域(thrombospondin type 1 domain-containing 7A,THSD7A)是近年发现的IMN第二个靶抗原,文献报道THSD7A可用于诊断、病情评估,尤其与肿瘤关系密切,但目前尚未在临床上广泛应用。现将我们诊治的1例THSD7A相关性膜性肾病患者并结合文献回顾阐述报告。

图1 患者肾活检病理图片注:A:PAS×400;B:Masson×400;C:IgG免疫荧光×200;D:IgG4免疫荧光×200;E:THSD7A免疫荧光×200;F、G:电镜×50 000;免疫荧光(图C~E)分别可见IgG(3+)、IgG4(3+)和THSD7A(+/-),均呈细颗粒状沿毛细血管壁沉积;电镜(图F、G)可见毛细血管内皮细胞空泡变性,基底膜轻度不规则增厚,上皮下少量电子致密物沉积。系膜区可见系膜细胞和基质增生,肾小管上皮细胞空泡变性
图2 患者治疗前后24 h尿蛋白量变化
图3 患者治疗前后白蛋白变化
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