特发性膜性肾病29例临床特点和治疗分析

目的回顾性分析特发性膜性肾病（IMN）的临床表现、病理特点及治疗效果。方法选取2009年1月至2011年12月经过肾穿刺活检确诊的IMN患者29例，记录并分析各项临床资料。结果29例患者中年龄〉40岁22例，占75．9％。男女之比是1．64：1。19例（65．5％）患者临床表现为肾病综合征（NS）。主诉为水肿23例（79．3％）。泡沫尿14例（48．3％），伴血压升高7例（24．1％），伴镜下血尿21例（72．4％），伴。肾功能不全1例（3．4％）。IMN患者24h尿蛋白定量明显增加，血清白蛋白明显降低，血脂明显升高，总钙明显降低，纤维蛋白原（FIB）明显升高，免疫球（FIB）蛋白G明显降低（P〈0．01），高密度脂蛋白和补体C3与正常参考值比较差异无统计学意义（P〉0．05）。IMN肾脏病理改变以Ⅰ期、Ⅰ～Ⅱ期和Ⅱ期为主，共占96．6％。其中10例（34．5％）具有小管间质损伤。13例随诊患者中治疗12个月时8例（61．5％）完全缓解，4例（30．8％）部分缓解。结论IMN多见于中老年，男多于女，其临床表现、实验室检查、病理学表现存在一定的特点和规律，激素联合环磷酰胺冲击治疗的方案有效。

Objective To retrospectively analyze clinical manifestations, pathological changes and therapeutic effects of idiopathic membranous nephropathy （ IMN ） . Methods 29 patients with IMN were recruited according to the results of kidney biopsy. All of the clinical data was recorded and analyzed. Results The patients aged over 40 years old accounted for 75.9%. The ratio of men to women was 1.64： 1. The patients with nephrotic syndrome （ NS ） accounted for 65.5%. 23 cases （79.3%） had a chief complaint of edema. 14 cases （48.3%） had bubble urine. 7 cases （24.1%） had elevated blood pressure. 21 cases （ 72.4% ） had microscopic hematuria. One case （ 3.4% ） had renal insufficiency. 24h urine protein, blood lipids （ TC, TG, LDL, Lpa ） and FIB increased significantly （ P〈0.01 ） . Serum albumin, total calcium and IgG reduced significantly （ P〈0.01 ） . There were not significant differences in the levels of HDL and C3 compared with the normal reference values （P〉0.05） . The cases of MN stage I , stage I - lI and stage ]] accounted for 96.6%. 10 cases （ 34.5% ） had renal tubulointerstitial injury. 8 cases （ 61.5% ） experienced complete remission, 4 cases （ 30.8% ） experienced partial remission in 13 follow-up patients. Conclusion IMN is more commonly found in middle and old people and males patients are more than females. There are certain features and regularities upon its clinical manifestations, laboratory tests and pathological changes. The therapeutic regimen of corticosteroids combined with pulse cyclophosphamide is effective.