成人特发性膜性肾病的预后分析

Prognosis analysis of idiopathic membranous nephropathy in adults

目的探讨影响特发性膜性肾病预后的临床及病理学特点。方法回顾性地分析1991～2006年在我院经肾穿证实的52例特发性膜性肾病患者的病历资料,以最后1次门诊复查或进入终末期肾病(肌酐升高1倍、死亡、进入尿毒症期)作为随访终点,分为终末期肾病组及肾功能稳定组。分别记录两组患者的各项指标,Logistic回归分析对预后的影响。结果 52例患者均接受了激素联合免疫抑制剂治疗,男性30例,女性22例,共有42例(80.77%)患者肾功能保持稳定,10例(17.8%)患者发展为终末期肾病。两组患者男性比例、平均动脉压、临床表现为肾病综合征患者比例、尿蛋白定量、胆固醇、血尿酸、肾小球滤过率、肾小管间质损害情况差异有统计学意义;24 h尿蛋白定量分为0～4 g,4～8 g,>8 g三个级别,两组患者比较差异有统计学意义。多因素Logistic回归分析显示,男性比例、尿蛋白定量、肾小管间质损害、肾小球滤过率是膜性肾病患者肾功能进展的独立危险因素。结论男性、大量蛋白尿、肾小管间质损害、较低的肾小球滤过率是肾功能进展的危险因素。临床中可根据危险因素存在的情况制定治疗方案。

Objective To assess the clinicopathological features and their relations with the prognosis of idiopathic membranous nephropathy （IMN）. Methods Fifty-two patients with IMN biopsied between 1991 and 2006, who were fol- lowed up for at least 52 months or till end-stage renal failure （double serum creatinine, death or dialysis）, were retrospec- tively analyzed. According to renal function, 52 patients were divided into stable renal function group and end stage renal disease group. The factors that irffluenced kidney prognosis were analyzed using Logistic regression analysis. Results Of the 52 IMN patients treated with corticosteroids and immunosuppressive drugs, 10 patients progressed to end stage renal disease, and 42 maintained renal function. There were significant differences in gender, mean arterial pressure （MAP） , nephrotic syndrome, cholesterol, triglycerides （TG）, glomerular filtration rate （GFR）, tubulointerstitial fibrosis between these two groups. Logistic regression analysis showed that gender, 24 h urinary protein, GFR, tubulointerstitial fibrosis were related to renal progression. Conclusion Gender,24 h urinary protein,GFR and tubulointerstitial fibrosis may be important factors that influence IMN outcome. In clinical practice, different treatment options should be chosen according to the exist- ing factors.