41例成人原发性膜增殖性肾炎的临床与病理分析

Clinicopathological analysis of 41 Patients with Idiopathic Membranoproliferative Glomerulonephritis

目的:探讨原发性膜增殖性肾小球肾炎(MPGN)的临床与病理特征,以及对治疗的反应。方法:对41例MPGN的临床及病理进行总结,比较不同病理类型、不同发病年龄的临床特点及对治疗的反应。结果:41例MPGN患者临床表现以蛋白尿、血尿、水肿多见,50%以上患者有肾病综合征、高血压、肾功能减退。病理有肾血管病变、肾小管间质病变者,临床表现重,高血压和肾功能减退较多见,肾小管功能差。儿童患者症状较成人轻,肉眼血尿较成人多见,而高血压和肾功能减退较成人少见,治疗反应较成人好。糖皮质激素加霉酚酸酯(MMF)治疗,能减少蛋白尿、改善肾功能,不良反应少。结论:成人MPGN临床表现重,单用激素治疗难以奏效,糖皮质激素联合MMF治疗MPGN安全有效。

Objective：To analysis the clinical, pathological features of Idiopathic Membranoproliferative Glomerulonephritis （MIEN）, and the reaction to therapy. Methods：Forty- one MPGN patients were investigated. The clinical features and the reaction to therapy of different pathological type and patients of different age were compared. Results：Clinically,most patients presented with proteinuria, hematuria and edema. Almost fifty percent of the patients had nephrotic syndrome, and impaired renal function impairment. Patients with in renal vascular impairment and renal tubulointerstitial abnormalities in the renal biopsy specimens precented with more serious clinical manifestation. Most of these patients had hypertension and impaired renal function impairment and tubular function. Glucoorticoid and Mycophenolate Mofetil（MMF） therapy significantly reduced the frequency of proteinuria and improved renal function with little adverse effect. Conclusion：The dinieal manifestation of MPGN in adults are more serious, and tend to be less responsive to treatment. Glucocorticoid and Mycophenolate Mofetil（MMF） therapy might be safe and effective.