71例膜性肾病的临床特点和病理分期及治疗观察

The Observation on Clinical Features,Pathological Staging and Treatment Effects of 71 Patients with Membrance Nephropathy

目的探讨成年人膜性肾病的临床特点、病理分期及治疗方法。方法对2007年10月至2011年10月在包头医学院第一附属医院经肾穿刺活检确诊的71例膜性肾病患者的临床、病理分期及治疗观察资料进行归纳总结。结果膜性肾病好发于30岁以上成人,以Ⅰ期膜性肾病多见。各期主要以水肿为首发症状。24 h尿蛋白定量<3.5 g,血浆白蛋白正常或轻度降低,可只予血管紧张素转换酶抑制剂及辅助治疗。24 h尿蛋白定量>3.5 g、临床症状明显,采用激素加环磷酰胺治疗可以缓解原发性膜性肾病,减少尿蛋白,保护肾功能。结论膜性肾病临床及病理表现各异,虽部分病例可自发缓解,但对于大量蛋白尿患者,应及早联合治疗。

Objective To explore the clinical teatures, pathological staging and treatment effects of the patients with membranous nephropathy. Methods The clinical data of 71 cases with membranous nephropa- thy diagnosed by renal biopsy were collected from the First Affiliated Hospital of Baotou Medical College from Oet. 2007 to Oct. 2011. The clinical features, pathology and treatment effect were summarized based on the data. Results Membranous nephropathy often occurs in adults over 30 years. The patients in stage I consti- tute the major part. Edema is usually the first symptom of the disease at various stages of the disease. When the 24h urinary protein quantity was less than 3.5g and plasma albumin was normal or slightly low, the patients can be given angiotensin converting enzyme inhibitors and other adjuvant treatment. When 24h urina- ry protein quantity was more than 3.5g and the elinical symptoms were more obvious, the patients should be treated with glucocorticoids cgmbined with cytoxan to relieve the primary membranous nephropathy, reduce the proteinuria, and protect the renal function. Conclusion The clinical manifestations and pathological fea- tures of membranous nephropathy vary greatly. The patients with heavy proteinuria should be treated with the eombination of medicines as early as possible although a part of cases may suontaneouslv relieve.