不同性别的原发性膜增殖性肾炎的临床及病理分析

Clinical and pathological analysis of patients with primary mesangial proliferative giomerulonephritis in different genders

目的了解不同性别的原发性膜增殖性肾炎（MPGS）的临床、病理特点及性别间差异。方法回顾性分析我院105例MPGS患者的临床及病理资料。结果（1）男性占71．43％（75／105），女性占28．57％（30／105）。（2）平均年龄：男（40．25±15．50）岁，女（36．23±15．26）岁，男女差别无统计学意义（t=1．206，P〉0．05）。（3）临床表现：在病程长短和血尿、水肿、高血压的发生率及平均血压方面两组差异均无统计学意义（P均〉0．05），血尿占56．19％（59／105）。临床主要表现为肾病综合征，男、女性分别为69．33％（52／75）、63．33％（19／30），男女差异无统计学意义（x2=0．352，P〉0．05）。（4）实验室检查：尿蛋白定量、血浆自蛋白、血免疫球蛋白、补体、尿素氮、肌酐男女间比较差异均无统计学意义（P均〉0．05），补体C3降低占53％（53／100）。合并肾功能不全男性为24．00％（18／75），女性13．33％（4／30），差异无统计学意义（x2=1．472，P〉0．05），尿素氮的平均值高于正常。（5）病理方面：免疫荧光检查除无小球的5例（男3、女2）外，有不同免疫复合物沉积男性占93．06％（67／72），女性92．86％（26／28），两组差异无统计学意义（x2=0．001，P〉0．05）。（6）危险度评价，性别间差异无统计学意义（x2=1．696，P〉0．05）。结论MPGS男性多发；临床主要表现为肾病综合征，血尿、补体c3降低、肾功能不全的发生率较高，男女性别间无差异。

Objective To understand the differences between sexes in the clinical and pathological features of patients with mesangial proliferative glomerulonephritis （MPGS）. Methods One hundred and five patients with MPGS admitted to our hospital were retrospectively studied in clinical and pathological aspects. Results （ 1 ） The proportion of male patients were 75 of 105 （71.43% ） and that of females were 30 of 105（28.57% ）;（2）The average age of the male patients was（g0. 25 ＋ 15.50）and that of the females was （36. 23 ＋ 15.26）in year. There was no significant difference between the two groups（ t = 1. 206 ,P = 0. 231 ）; （3） There was no significant difference in duration of disease, hematuria, edema, hypertension prevalence and mean blood pressure（P 〉 0. 05 ）. The proportion of patients with hematuria was 56. 19% （59/105）.The males accounted for 69. 33% （52/75）and the females were 63.33% （19/30）in the main clinical manifestations of nephrotic syndrome. There was no significant difference（ ~2 = 0. 352, P 〉 0.05 ）between the proportion of males and females; （4）Males and females groups had no significant difference（P 〉 0. 05 ）on levels of urinary protein, serum albumin,immunoglobulin, complement, urea nitrogen and serum creatinine. Complement decreased in 53 cases,accounting for 53% of all the participants. The proportion of male patients with renal insufficiency was 24.00% （18/75）, and the proportion of females with renal insufficiency was 13.33% （4/30）. There was no significant difference （X2 = 1.472, P 〉 0.05 ） on the percentage of males and females with renal insufficiency. The mean value of urea nitrogen was higher than the normal levels; （ 5 ） The proportion of male cases with different deposition of immune complexes was 93.06% （67/72）, and the proportion in females were 92. 86% （26/28）in the exception of 5 cases （male 3 and female 2）with no glomeruli in immunofluorescence examination. No significant difference was found between the two groups（ X2 = 0. 001 ,P 〉 0. 05 ） ;（ 6 ）There was no significant gender differences（ X2 = 1. 696 ,P 〉 0.05 ） found in risk assessment. Conclusion The prevalence of MPGS is higher in male patients than in females, the main clinical manifestations of which were nephrotic syndrome. Patients were found to have a higher rate of hematuria, decreased complement C3, and renal dysfunction than the normal levels. There was no significant difference in gender on the clinical and pathological aspects of MPGS.