成人三种膜性肾病的临床与病理分析

Comparative study of clinical and pathological features of membranous nephropathy in adults

目的阐明成人病理类型表现为膜性肾病的乙肝相关性肾炎、狼疮性肾炎、特发性膜性肾病的临床与病理特点。方法回顾性分析经肾活检确诊的三种膜性肾病患者86例,对其临床资料、病理特征进行统计分析。结果①三种膜性肾病占有率为乙肝相关性肾炎11.6%、狼疮性肾炎24.4%、特发性膜性肾病64.0%。②三种膜性肾病患者临床表现均以肾病综合征为主,而血尿、高血压及肾功能不全的发病情况在三者间无统计学意义。血清补体C3、C4的降低在狼疮性肾炎患者中明显。③病理改变均以Ⅰ期、Ⅱ期为主,在病理表现中,系膜中重度增生、电子致密物多部位沉积在乙肝相关性肾炎、狼疮性肾炎和特发性膜性肾病间比较有显著差异(P<0.05)。结论成人以特发性膜性肾病为主,三种膜性肾病的临床表现相似,但有各自临床与病理特点,确诊需综合进行分析。

Objective To discuss the clinical and pathological features among idiopathic membranous nephropathy, hepatitis B related membranous nephropathy and lupus nephritis in adults. Methods Eighty - six patients with membranous nephropathy were selected in this study. The clinical manifestation and renal pathological characteristic were compared between the three types of membranous nephropathy. Results ①10 patients with Hepatitis B related membranous nephropathy （11.6%） ; 21 patients with lupus nephritis （24.4%） ; and 55 patients with idiopathic membranous nephropathy （64.0%） ②Most of patients with membranous nephropathy presented nephrotic syndrome. The incidence of hypertension, hematuria and renal insufficiency were no significant differences among three groups. Serum C3 and CA have decreased significantly in lupus nephritis. ③At the time of renal biopsy, the most patients are classified as stage Ⅰ or Ⅱlesions. There were significant differences of moderate to severe mesangium cell proliferation, variety immune complex deposit among idiopathic membranous nephropathy with hepatitis B related membranous nephropathy and lupus nephritis in adults. Conclusion Idiopathic membranous nephropathy is the common reason in adults. There are some differences in clinical manifestation and renal pathology among three groups respectively, which is helpful to differential diagnosis.