膜性肾病49例临床特点及治疗分析

Clinical study on 49 cases of patients with membranous nephropathy

目的回顾性分析我院就诊膜性肾病患者的流行病学资料、临床表现、病理类型、治疗措施、疗效及并发症等方面的特点。方法选择我院1998年10月～2009年10月经过肾穿刺活检确诊的膜性肾病患者,分析其年龄、性别等流行病学资料,并根据病理结果分为Ⅰ期膜性肾病组、Ⅱ期膜性肾病组、Ⅲ期膜性肾病组、不典型膜性肾病组,对比分析各组临床表现、治疗措施、治疗效果。结果膜性肾病共有49例,年龄13～78(48.5±16.1)岁,男∶女为1.1∶1。其中肾病综合征37例。主诉为浮肿46例,平均病程5个月。伴镜下血尿38例,伴肾功能不全8例(其中2例需要透析治疗),伴胸水8例,伴腹水10例,伴阴囊水肿2例,伴高血压20例,伴糖尿病7例,伴类风湿性关节炎3例,伴肿瘤3例,伴肺结核3例。病理结果示:Ⅰ期27例(55.1%)、Ⅱ期14例(28.6%)、Ⅲ期2例(4.1%)、不典型6例(12.2%)。分期较大者平均年龄较大、平均病程较长、疗效较差。肾综患者24h尿蛋白定量(6.8±2.8)g,血清TP(40.4±6.4)g,ALB(24.7±6.7)g,TG(2.3±1.6),TCH(8.1±3.0)mmol/L。9例单用激素治疗,2例病情缓解。激素加免疫抑制剂治疗19例,其中12例病情缓解,2例无效,5例失访。单用免疫抑制剂3例。未用激素或免疫抑制剂者18例。结论膜性肾病是肾穿刺活检较常见的病理类型,主要表现为肾脏综合征,常常合并其它疾病,治疗方案需要根据患者病情灵活确定。

Objective To retrospectively analyze the epidemiology data,clinical presentation,pathological changes,therapy protocols and effects,omplications of the 48 cases of patients with membranous nephropathy （MN）.Methods The MN patients from Oct.1998 to Oct.2009 in the database of renal puncture in our hospital were chosed.Their epidemiology data such as age,sex etc.was analyzed.They were divided into 4 groups according to their pathological stage： stage 1,2,3 and non-typical MN.The clinical presentation,therapeutic protocol and effect between groups were analyzed and compared.Results There were 49 cases of MN patients,age 13～78（48.5±16.1）years,male and female ratio 1.1∶1.There were 37 cases of nephrotic syndrome,and 46 cases with complaint of edema.Their average duration was 5 monthes.There were 38 cases with hematuria,8 with renal insufficiency （2 cases with hemodialysis）,8 with hydrothorax,10 with ascites,2 with scrotum edema,20 with hypertension,7 with diabetes mellitus,3 with rheumatoid arthritis,3 with tumour,and 3 with tuberculosis.In pathology,there were 27 cases （55.1%） in stage Ⅰ,14 cases （28.6%） in stageⅡ ,2 ases （4.1%） in stage Ⅲ,and 6 cases （12.2%） of non-typical.The higher the stage,the older the age,the longer the duration,and the worse the effect.In patients with nephrology syndrome,24h urine protein was （6.8±2.8）g,serum TP（40.4±6.4）g,ALB（24.7±6.7）g,TG（2.3±1.6）,TCH（8.1±3.0）mmol/L.9 cases were treated with cortical steriod （2 effective）,19 cases plus cell intoxicant drugs （12 effecitve）,3 cases with cell intoxicant drugs along,18 cases without both.Conclusion MN is one of the common disease in renal puncture.The main manifestation of MN is of nephrotic syndrome,and combined with other diseases frequently.The treatment should be individualized.