特发性膜性肾病与膜增生性肾炎的比较

Comparison between idiopathic membranous nephropathy and membranoproliferative nephritis

目的对比分析特发性膜性肾病(IMN)与原发性膜增生性肾炎(PMPGS)的临床与病理资料,了解其特点及两者的区别。方法对比分析我院近20年来IMN(551例)与PMPGS(105例)的临床病理资料。结果①IMN和PMPGS均为男性多于女性,两组男女比例比较差异无统计学意义(P>0.05);②IMN及PMPGS的平均年龄分别为(47.22±16.32)岁、(39.10±15.47)岁,差异有统计学意义(P<0.01);③IMN的病程中位数为4月,其中50%的病例在(1～11)月,PMPGS病程中位数为6月,其中50%的病例在(3～24)月,两组差异有统计学意义(P<0.01);④IMN及PMPGS均以肾病综合征为主,两组差异无统计学意义;⑤IMN及PMPGS有血尿者分别占33.76%(186/551)及56.19%(59/105),差异有统计学意义(P<0.01);⑥两组血压、尿蛋白定量、血白蛋白浓度、血IgG、IgA浓度比较差异无统计学意义(P>0.05),但血中IgM、C3、C4的浓度及补体(C3)降低的比例比较,差异有统计学意义(P<0.01);⑦两组合并肾功能不全以及血中尿素氮、肌酐的浓度比较,差异有统计学意义(P<0.01);⑧总体疾病危险度比较,两组差异有统计学意义(P<0.01);⑨两组在肾脏免疫病理表现方面,均有较强的免疫球蛋白沉积,但IMN较PMPGN免疫荧光沉积强,两组比较差异有统计学意义(P<0.01)。结论①两种疾病均为男性多于女性;②临床主要表现为肾病综合征;③PMPGS较IMN血尿常见,补体(C3)降低的比例高;④IMN在肾功能损害合并肾功能不全及疾病危险度的评价较PMPGS轻。

Objective To understand the characteristics of idiopathic membranous nephropathy(IMN) and primary membranoproliferative glomerulonephritis(PMPGS) and their differences based on contrastive analysis of their clinical and pathological information.Methods We made a contrastive analysis of clinical and pathological information of IMN(551 cases) and PMPGS(105 cases) in the past 20 years in our hospital.Results ① Male patients outnumbered female ones in both groups with little difference(P>0.05).② Significant differences were found between IMN and PMPGS in average age,namely,(47.22±16.32) and(39.10±15.47),respectively(P<0.01).③ Large differences between IMN and PMPGS in median course of disease,namely,4 and 6 months,respectively;the course of disease ranged 1-11 months in IMN and 3-24 months in PMPGS in 50% cases,respectively(P<0.01).④ Nephritic syndrome was the major clinical manifestation in both groups with little difference(P>0.05).⑤ Hematuria occurred in 33.76%(186/551) of IMN patients and 56.19%(59/105) of MPGS ones,with significant difference(P<0.01).⑥ The two groups did not differ significantly in blood pressure,quantitative analysis of urinary album,concentration of album,IgG and IgA(P>0.05),but in concentration of IgM,C3 and C4 and the ratio of existing complement reduction(C3)(P<0.01).⑦ Large differences were found in incidence of renal insufficiency as well as the concentration of BUN and Scr between IMN and PMPGS(P<0.01).⑧ As to the overall disease risk degree,there were large differences between the two groups(P<0.01).⑨ Pathological features: Although immunoglobulin deposition was strong in both diseases,it was significantly stronger in IMN than in PMPGS(P<0.01).Conclusion ① Male patients outnumber female ones in both diseases.② Nephritic syndrome is the major clinical manifestation.③ Hematuria is more common in PMPGS than in IMN;the ratio of existing complement reduction(C3) is higher in PMPGS.④ Renal functional lesion is not so serious in IMN as in PMPGS.