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论著:马兜铃酸肾病导致终末期肾病合并肿瘤的临床研究
Study on Malignancy in End Stage Aristolochic Acid Nephropathy
陈利明 邹建洲 刘中华 方艺 刘红 刘春凤 钟一红 滕杰 吉俊 章晓燕 丁小强
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作者单位:复旦大学附属中山医院肾内科
中文关键字:马兜铃酸;终末期肾病;血液透析;肿瘤
英文关键字:Aristolochic acid;End stage renal disease;Hemodialysis;Malignancy
中文摘要:目的:探讨患有马兜铃酸肾病(aristolochic acid nephropathy,AAN)所致终末期肾病(end stage renal disease,ESRD)并进行维持性血液透析的患者中的肿瘤发生情况及临床病理特点。方法:收集17例符合AAN诊断标准的肿瘤患者,分析其服用含马兜铃酸(aristolochic acid ,AA)中药的情况、肾脏病理、肿瘤的类型和病理特点。结果:17例患者服用含AA中药时间为(3.40±2.52)年,服药后至血液透析的时间为(8.74±11.14)年,服药至肿瘤发生时间为(12.59± 11.29)年;其中,4例服用含AA的中草药汤剂,4例服用甘露消毒丸,3例服用龙胆泻肝丸,3例服用冠心苏合丸,2例服用排石汤,1例服用含AA的减肥药。肾脏病理检查光镜示肾小球结构大致正常,小管上皮细胞空泡样变性,小管萎缩、坏死及弥漫性间质纤维化;电镜示肾间质胶原纤维增多。肿瘤发生情况为:泌尿系肿瘤10例,包括肾透明细胞癌4例,膀胱乳头状移行细胞癌3例,肾盂乳头状移行细胞癌1例,输尿管乳头状移行细胞癌1例,尿路上皮癌1例;消化道肿瘤4例,包括结肠腺癌2例,肝细胞癌2例;乳腺浸润性导管癌3例。其中,复合性肿瘤4例,包括膀胱癌合并肾盂癌2例、膀胱癌合并输尿管癌1例、乳腺癌合并膀胱癌1例。结论:AAN可导致ESRD和多脏器肿瘤,以泌尿系肿瘤高发,常合并复合性肿瘤。
英文摘要:Objective: To investigate the clinical and pathological features of malignancy in patients with end stage aristolochic acid nephropathy (AAN) undergoing maintenance hemodialysis . Methods: A total of 17 patients with AAN underwent maintenance hemodialysis were enrolled in this study. Patients’ renal biopsy results, medical history of aristolochic acid (AA) inges tion and histology patterns of malignancies were retrospectively reviewed. Results: The mean course of treatment with Chinese herbal medicine containing AA was 3.40 ± 2.52 years. The mean interval between AA treatment and hemodialysis initiation was 8.74 ± 11.14 years, while the mean interval from AA treatment to the final diagnosis of malignancy was 12.59 ± 11.29 years. Of the 17 cases, four took herbal decoction containing AA, four took Gan Lu Xiao Du pills, three took Long Dan Xie Gan pills, three took Guan Xin Su He pills, two took Pai Shi Tang and one patient took diet pills containing AA. Renal pathology revealed normal glomeruli but marked tubulointerstitial lesions like tubular epithelial cell vacuolar degeneration, tubular atrophy, tubular necrosis or diffuse interstitial fibrosis. Electron microscopy showed increased deposition of collagens in renal interstitium. The coexisting malignancies including 10 cases of urinary tract tumors( renal transparent cell carcinoma in 4 cases , bladder papillary transitional cell carcinoma in 3 cases , renal pelvis papillary transitional cell carcinoma in 1 case, ureteral papillary transitional cell carcinoma in 1 case and urothelial carcinoma in 1 case); four cases of gastrointestinal cancer (colon adenocarcinoma and hepatocellular carcinoma, each in 2 cases); three cases of breast invasive ductal carcinoma. Besides, four were of composite tumor, including bladder cancer with renal pelvis cancer in 2 cases,bladder cancer with ureteral carcinoma in 1 case, breast cancer with bladder carcinoma in 1 case. Conclusions: AAN could develop to ESRD and maligancies(mostly urinary tract tumors, sometimes composite tumor).
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