肾小球膜性病变的病因分析及流行病学特点

Etiology and epidemiology of membranous nephropathy

目的:了解我国肾小球膜性病变的病因及流行病学特点。方法:分析统计南京军区南京总医院解放军肾脏病研究所经肾活检确诊的肾小球膜性病变418例,将其与国外资料进行比较。结果:(1)特发性膜性肾病占29·67%,继发性膜性肾病占70·33%。(2)特发性膜性肾病平均年龄(43·94±13·12)岁,男女比例1·53∶1。临床主要表现为蛋白尿、肾病综合征和高血压。蛋白尿>3·5g/24h的发生率为39·52%。(3)特发性膜性肾病中,男性高血压发生率显著高于女性(37·33%vs18·37%,P<0·05),男性大量蛋白尿的发生率略高于女性(P>0·05)。(4)继发性膜性肾病的病因包括自身免疫性疾病(66·33%)、感染(15·99%)、糖尿病(9·52%)、肿瘤(4·08%)、药物及毒物诱发(4·08%);最常见的病因依次为系统性红斑狼疮(56·12%)、乙型肝炎(16·33%)、糖尿病(9·52%)。结论:我国肾小球膜性病变以继发性膜性肾病为主。特发性膜性肾病以男性、中年多见;肾病综合征发生率相对较低;男性患者高血压、大量蛋白尿发生率高于女性,提示男性预后较差。继发性膜性肾病最常见病因为系统性红斑狼疮、乙型肝炎和糖尿病。

Objective：To investigate the etiology and epidemiology of membranous nephropathy （MN） in Chinese patients. Methodology：Four hundreds and eighteen biopsy-proven MN patients were enrolled in this clinical study. The results were compared with those of previous published reports to observe whether any differences between Japanese and Caucasian patients. Results ： （ 1 ） Totally 29.7% MN patients were idiopathic. （2） The average age of patients with idiopathic MN was （43.9 ± 13. 1 ） years old. The male ratio to female in this group was 1.53： 1. The manifestation included proteinuria, nephrotie syndrome and hypertension. The level of proteinuria more than 3.5 g/24h was 39.5%. （3） In the idiopathic MN, more male patients suffered hypertension （ 37.3% vs 18.4% , P 〈 0. 05 ） and excessive proteinuria （ P 〉 0. 05） than the female patients did. 4. The original disease of the secondary MN patients included autoimmune diseases （ 66. 3 % ） ,infections （ 17. 0% ） , diabetes （ 9. 52 % ）, tumours （ 4. 08 % ） and renal toxicity （ 4. 08 % ） and the most common disease was systemic lupus erythema （SLE） （56. 1% ） ,hepatitis B （ 16. 3% ）and diabetes （9. 52% ）. Conclusion：Idiopathic MN is more common in male and middle age patients. Nephrotic syndrome is relatively scarce. Hypertension and heavy proteinuria is more common in male patients, which indicates the prognosis of male MN patients might be inferior. SLE, hepatitis B and diabetes are the most common original diseases in Chinese patients.