特发性与继发性膜性肾病的临床与病理分析

Clinicopathological analysis of membranous nephropathy

目的了解肾小球膜性病变的病因及临床、病理特点。方法分析统计我院肾脏病研究所经肾活检确诊的肾小球膜性病变189例。结果①特发性膜性肾病占28．57％，继发性膜性肾病占71．43%；②特发性膜性肾病平均年龄（46．24±15．31）岁，男女比例1.46：1。临床主要表现为蛋白尿、肾病综合征、高血压。肾病综合征的发生率为45．51％；③继发性膜性肾病最常见的病因依次为系统性红斑狼疮（70．37%）、乙型肝炎（28．89％）、银屑病（0．74％）。结论我院。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，大多为。肾病综合征；继发性膜性肾病最常见病因为系统性红斑狼疮、乙型肝炎和银屑病，病理分期主要为Ⅰ～Ⅱ级，病理表现中系膜细胞和基质增生在特发性膜性肾病和乙型肝炎病毒相关性肾炎、狼疮性肾炎之间差异显著。

Objective To discuss the clinicopathological features of idiopathic membranous nephropathy（MN） vs secondary MN. Methods /89 patients with MN were selected in this study. The clinical manifestation and renal pathological characteristic were compared between the idiopathic MN and secondary MN. Results （1） Totally 28. 57% MN patients were idiopathic and 71.43% secondary respectively. （2） The average age of patients with idiopathic MN was （46. 24 ± 15.31） years old. The ratio of male to female in this group was 1.46 ： 1. The manifestation included proteinuria, ne phrotic syndrome and hypertension. 45.51% patients with MN presented nephrotic syndrome. （3） The original disease of the secondary MN patients included systemic lupus erythema（SLE）（70.37%）, hepatitis B（28.89%） and psoriasis（0.74%）. Conclusions Idiopathic MN is more common in male and middle age patients. Nephrotic syndrome is relatively scarce. At the time of renal biopsy, the most patients are classified as stage Ⅰ or Ⅱ lesions. There were significant differences in moderate to severe mesangical cell proliferation between idiopathic MN with hepatitis B related MN and lupus nephritis.