特发性膜性肾病患者的病理特点和预后分析

Pathological characteristics and prognosis of patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病(IMN)患者(18~50岁)的病理特点和预后情况。方法将125例经检查确诊IMN的患者作为研究对象,收集患者资料分析相关病理特点及预后情况。结果本组患者中,男80例,女45例,男性占比更高;病理分期Ⅰ期的患者年龄、性别、血肌酐、肾小球滤过率、24 h尿蛋白指标与Ⅱ期患者、Ⅲ期和Ⅳ期患者比较,差异有统计学意义(P<0.05);肾小管间质慢性病变患者的年龄、性别、血肌酐、肾小球滤过率、24 h尿蛋白指标与肾小管间质正常的患者比较,差异有统计学意义(P<0.05);肾血管有病变的患者年龄、性别、血肌酐、肾小球滤过率、24 h尿蛋白指标与肾血管正常的患者比较,差异有统计学意义(P<0.05);有肾小球硬化的患者年龄、性别、血肌酐、肾小球滤过率、24 h尿蛋白指标与无肾小球硬化的患者比较,差异有统计学意义(P<0.05)。采用糖皮质激素治疗患者的预后情况与采用非特异性治疗的患者比较,差异无统计学意义(P>0.05)。结论IMN患者采用糖皮质激素治疗或非特异性治疗的预后情况无显著差异,病理分期、有无肾小球硬化、有无肾小管间质慢性病变、有无肾血管病变是IMN患者血肌酐、肾小球滤过率、24 h尿蛋白水平的影响因素。

Objective To investigate the pathological features and prognosis of patients(aged 18 to 50 years)with idiopathic membranous nephropathy(IMN).Methods A total of 125 patients confirmed as IMN were enrolled in the study.The relevant data of patients were collected,and their prognosis and pathological features were analyzed.Results There were 80 males and 45 females,with males accounting for a higher proportion.Age,gender,serum creatinine,glomerular filtration rate,24 h urine protein indicators of patients in pathological stageⅠshowed significant differences compared with those in stagesⅡ,ⅢandⅣ(P<0.05).The above indicators showed significant differences between patients with chronic renal tubulointerstitial lesions and those with normal renal tubulointerstitial,between patients with glomerular sclerosis and those without glomerular sclerosis,between patients with renal vessels lesion and those without(P<0.05).The prognosis of patients treated with glucocorticoids had no significant difference in patients with glucocorticoid therapy compared with those without non-specific treatment(P>0.05).Conclusion There is no significant difference in the prognosis of IMN patients with glucocorticoid therapy or non-specific therapy.Pathological stage,glomerular sclerosis,chronic tubulointerstitial lesions,and renal vascular disease are influencing factors of serum creatinine,glomerular filtration rate,and 24 h urine protein for IMN patients.