老年人原发性膜性肾病肾小动脉病变的特点

The pathological changes of renal arterioles in the elderly with idiopathic membranous nephropathy

目的观察老年原发性膜性肾病患者肾小动脉病变的发生情况及其特点。方法选取2000年1月至2005年12月在我院住院并经肾穿刺活检确诊的原发性膜性肾病患者168例，分为老年组（≥60岁）和非老年组（〈60岁），分析两组患者肾小动脉病变的发生情况及其影响因素。结果老年组收缩压、舒张压、血肌酐水平、血尿发生率显著高于非老年组，而eGFR则显著低于非老年组。肾小球球性或节段硬化的比例以及肾小管萎缩和肾间质纤维化程度老年组重于非老年组。肾脏小动脉病变的发生率以及严重程度均明显重于非老年组。多因素分析显示，高血压、年龄、肾小管间质慢性损伤是肾脏小动脉病变发生的独立影响因素。进一步将血压正常且小管间质病变匹配的老年与非老年组患者比较，老年患者肾小动脉病变的发生率以及严重程度仍重于非老年患者（P〈0．05），肾小动脉病变表现为肌层增厚，合并玻璃样变的比例高。结论老年原发性膜性肾病患者肾小动脉病变的发生率以及严重程度均明显高于非老年患者，合并玻璃样变的比率高，其可能是影响老年原发性肾脏病患者预后不良的重要因素。

Objective To observe the pathological changes of renal arterioles in the elderly with idiopathic membranous nephropathy. Methods One hundred and sixty-eight patients with clinical and biopsy-proven idiopathic membranous nephropathy from Jan 2000 to Dec 2005 were enrolled. The characteristics and influence factors of the renal arterioles lesions in the elderly group （44 cases） and non-elderly group （124 cases） were analyzed. Results The systolic blood pressure, diastolic blood pressure, the level of serum creatinine and the incidence of hematuria were higher in the elderly group, but the eGFR was lower. The ratios of global and segmental glomerulosclerosis and degrees of tubular interstitial damage and fibrosis were more severe in the elderly group than in the non-elderly group. There was a higher incidence and advanced lesions of renal arterioles in the elderly group（P〈0.05）. Multifactor analysis revealed that hypertension, age≥60 years and chronic tubulointerstitial lesions were independent factors for renal arterioles lesions. There was a higher incidence and advanced renal arterioles lesions in the elderly group than in the non-elderly group （all P〈0.05） even in those with normal blood pressure and paired tubulointerstitial lesions. And lesions of renal arterioles including muscular thickening with multiple layers of smooth muscle cells and more vascular hyalinosis were found in the elderly groups. Conclusions There is higher incidence and more severity of renal arterioles lesions and more vascular hyalinosis in the elderly with idiopathic membranous nephropathy. It might be an important factor influencing the disease progress and prognosis in the elderly patients.