川西南地区68例膜性肾病临床与病理分析

Clinical and pathological analysis on 68 cases of membranous nephropathy in the southwest area of province Sichuan

目的了解我国川西南地区膜性肾病(MN)的临床特征及其与病理改变的关系。方法回顾性分析2003年至2010年间在四川省攀枝花市中心医院肾内科住院的68例MN患者(均经肾活检及临床确诊),对其临床资料、病理特征进行统计分析。结果 (1)68例MN的病因主要为特发性膜性肾病(IMN),占82.4%;其次为狼疮性肾炎,占11.8%;乙型病毒性肝炎、类风湿性关节炎、干燥综合征少见,分别占2.9%、1.5%、1.5%。(2)68例MN患者临床表现为肾病综合征、慢性肾炎及隐匿性肾炎,分别占70.6%、22.1%及7.4%;伴有镜下血尿、高血压及肾功能不全者分别为52.9%、14.7%及4.4%。(3)Ⅰ、Ⅱ、Ⅲ和Ⅳ期分别占52.9%、44.1%、1.5%和1.5%。性别、年龄、高血压、血清白蛋白、胆固醇、24h尿蛋白定量及内生肌酐清除率水平等在不同肾小球病理分期间无显著差异。结论 (1)川西南地区MN病因主要为特发性膜性肾病,其次为狼疮性肾炎;(2)MN临床表现主要为肾病综合征,镜下血尿、高血压、肾功能不全的发生率与国外接近;(3)MN病理改变以I期、Ⅱ期为主;临床表现特征与肾小球病理分期无明显相关。

Objective To understand the relationship between clinical features and pathological changes in patients with membranous nephropathy （MN） in the southwest area of province sichuan in China. Methods The clinical data and pathological features of 68 patients with MN （ confirmed by both renal biopsy and clinic） admitted in our department from 2003 to 2010 were retrospectively analyzed. Results （ 1 ）The main causes of MN were in the order：idiopathic MN （IMN） accounting for 82.4% ,lupus nephritis accounting for 11.8%, hepatitis B, rheumatoid arthritis and Sjfigreu＇s syndrome accounting for 2. 9%, 1.5%, 1.5%, respectively. （ 2 ） The clinical manifestations of MN patients were accorded with nephrotic syndrome （70. 6% ） ,chronic nephritis （22. 1% ） ,and occult nephritis （7.4%） ,and the patients accompanying microscopic hematuria, hypertension and renal insufficiency were 52. 9% ,14. 7% and 4. 4% ,respectively. （3）The phase Ⅰ , Ⅱ, Ⅲand Ⅳ accounted for 52. 9% ,44. 1%, 1.5 % and 1.5 %, respectively. There were no significant differences in gender, age, hypertension, serum albumin,cholesterol,the fLxed quantity of 24 h urinary protein and endogenous creatinine clearance rate （Ccr） at different glornerular pathological phases. Conclusions （ 1 ） The main causes of MN are IMN, lupus nephritis followed in the southwest area of province sichuan. （2） The main clinical manifestation is nephrotic syndrome, and the incidences of microscopic hematuria, hypertension and renal insufficiency are closed to abroad. （3） The main pathological changes are in the phase Ⅰ and Ⅱ. There is no significant correlation between clinical feature and glomerular pathological stage.