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題名 | 腎絲球血尿中之紅血球形態(2):腎絲球血尿中之紅血球形態改變機轉之研究 |
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作者 | 陳遠浩; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 28:2 民76.03-04 |
頁次 | 頁94-100 |
分類號 | 415.1461 |
關鍵詞 | 血尿; 形態; 改變; 紅血球; 腎絲球; 機轉; |
語文 | 中文(Chinese) |
中文摘要 | 為暸解腎絲球血床中不正常(變形)紅血球形成的機轉,本研究以25位血床的病童及25住正常尿液的兒童為研究之對象,將其血浪中之正常然血球及永浪中不正常紅血球分別五鈴不同滲透濃度與不同pH值的溶浪及尿液中,以觀察其紅血球形態之變化。結果顯示;正常兒童血中細血球在不同的滲透濃度(200,800及1,400mOsm/kgH2O)與pH值(4,6及8)的溶液以及尿液(滲透濃度為230~828mOsm/kgH2O,pH值為5.61-7.10)中時,均沒有任何相同於腎絲球出血之不正常知血球形態的出現。將病童血中之紅血球值於病童或正常兒童的尿液中則,也沒有任何不正常細血球的出現,苦將病童尿液中之不正常細血球置於正常兒童的尿液中時,也不見原為不正常形態的紅血球有回復到正常形態的改變。雖然體外可造成與體內有相同(或近似)的滲透濃度與pH值,但仍不能複制如體內完全相同的環境,因此,不能完全排除扛血球形態不受滲透濃度與及pH值的影響,但也不雙造成如此不正常形態的知血球。我們認為腎絲球本身的變化,如腎絲球基底膜問的空隙,微血管的壓力為造成此種不正常(變形)紅血球的主要目素。當紅血球受到高微血管壓之作用而經腎絲球基底膜間空隙被壓擠出後,或許再繼續受到不同部位腎小管中的不同滲透濃度或pH等因素的作用,在這多種因素的影響下,而使得原有相當可逆性的紅血球也就變成了一不可逆的不正常形態之細血球出現於尿液中了。 |
英文摘要 | The morphology of urinary red cell of 25 glomerular hematuria and normal red cell morphology of 25 normal children, respectively, were examined in different pH and osmolality solutions. The results showed that neither the normal red cell morphology was influenced by different pH and osmolality, nor was the dysmorphic red cell from glomerular hematuria reversed. Because the in vitro results can not exactly duplicate as those in vivo, the effect of pH and osmolality can not be completely excluded. The glomerular changes such as those in capillary pressure and the size of the gap in the glomerular basement membrane, are thus considered to be the mian factors which influence the morphology of red cell by squeezing through a capillary gap. After entering the urinary space, the red cell will continue to be influenced by various pH and osmolality in the different nephron segments. All the above factors-squeezing, different pH and osmolality-may damage the red cell membrane, and change, red cell morphology into an irreversible, dysmorphic shape. |
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