不同年龄原发性膜增殖性肾小球肾炎患者的临床特征研究

Clinical Features of Primary Membranoproliferative Glomerulonephritis in Patients of Different Ages

目的探讨不同年龄原发性膜增殖性肾小球肾炎(MPGN)患者的临床特征。方法回顾性分析105例于1990年6月—2010年6月在我院住院的原发性MPGN患者的临床资料,将患者按年龄分为4组:1组11例,年龄<20岁;2组44例,年龄20～39岁;3组36例,年龄40～59岁;4组14例,年龄≥60岁。结果 (1)105例患者中男75例(63.7%),女30例(占36.3%);发病年龄为14～69岁,平均(39.2±15.5)岁,其中20～59岁者占76.2%(80/105)。(2)各组病程、水肿发生率、镜下血尿发生率比较,差异均无统计学意义(P>0.05);收缩压升高发生率及平均收缩压比较,差异均有统计学意义(P<0.05),且4组收缩压升高发生率和平均收缩压与其他3组比较,差异亦均有统计学意义(P<0.05)。(3)各组合并肾功能不全发生率比较,差异有统计学意义(P<0.05),且4组与2组间差异有统计学意义(P=0.019)。(4)各组尿蛋白定量、血清蛋白水平、总胆固醇水平比较,差异均有统计学意义(P<0.05),且1组尿蛋白定量和血清蛋白水平与2组、3组比较,3组和4组总胆固醇水平与1组、2组比较,差异均有统计学意义(P<0.05)。(5)各组免疫学指标平均水平及肾组织免疫荧光学表现比较,差异均无统计学意义(P>0.05)。(6)各组疾病危险度比较,差异有统计学意义(P=0.034),且1组与3、4组比较,2组与4组比较,差异均有统计学意义(P<0.05)。结论原发性MPGN好发于中年男性,临床主要表现为肾病综合征,以<20岁及≥60岁的患者较为明显,且老年患者(≥60岁)高血压发病率及疾病危险度较高,病情较重。

Objective To study the clinical characteristics of primary membranoproliferative glomerulonephritis （MPGN） in patients of different ages. Methods A retrospective analysis was performed on the clinical data of 105 MPGN pa- tients admitted from June 1990 to June 2010. Patients were divided, based on age, into groups Ⅰ （ 〈20 years old, n = 11 ）, Ⅱ （ 20 - 39 years old, n=44）, Ⅲ （40-59 years old, n=36）, Ⅳ （≥60yearsold, n=14）. Results （1） Inthe 105 patients there were 75 males （63.7%）, 30 females （36. 3% ） ; The ages of onset were 14 - 69, averagely （39. 2 ± 15.5 ） years old, thereinto patients aged 20 -59 accounted for 76. 2% （80/105）. （2） There was no significant difference in disease duration, incidence of edema or microscopic hematuria between 4 groups （ P 〉 0. 05 ） , but there was in incidence of elevated systolic blood pressure （SBP） and average SBP （ P 〈 0.05 ）, and group Ⅳ was different from groups Ⅰ ,Ⅱ and Ⅲ （ P 〈 0. 05 ）. （ 3 ） There was significant difference in incidence of renal insufficiency between 4 groups （ P 〈 0.05 ）, and between groups Ⅳ and Ⅱ （P =0. 019）. （4） There was significant difference in urine protein, serum albumin level, total cholesterol （ TC ） between 4 groups （ P 〈 0.05 ）, and group Ⅰ was different from groups Ⅱ and Ⅲ in urine protein, serum albumin, groups Ⅲ andⅣdifferent from groups Ⅰ , Ⅱ in TC （P 〈 0.05）. （5） No significant difference was noted in average immuno- logical parameter or renal tissue immunofluorescence tests （ P 〉 0. 05 ）. （6） There was significant difference in disease risk be- tween 4 groups （ P = 0. 034 ） , and group Ⅰ was different from groups Ⅲ and Ⅳ, group Ⅱdifferent from group Ⅳ （ P 〈 0. 05 ）. Conclusion Primary MPGN occurs more often in middle - aged males, manifesting clinically as nephritic syndrome and more remarkable in patients 〈 20 or ≥60 years old. Hypertension incidence and risks are high and condition is severe in elderly patients aged ≥60 years old.