老年人特发性膜性肾病临床特点及临床与病理的关系

Analysis of clinical and pathological relationship of idiopathic membranous nephropathy in elderly patients

目的 了解老年人特发性膜性肾病的临床病理特点及其关系. 方法 回顾性分析我院近10年诊断为特发性膜性肾病老年患者（年龄≥60岁,老年组）的临床及病理资料,并与同期特发性膜性肾病非老年患者（年龄＜60岁,对照组）的资料进行比较. 结果 老年组及对照组均以男性多见,分别占57.4％和59.2％,两组在性别构成方面差异无统计学意义（Х^2=0.254,P＞0.05）;老年组及对照组特发性膜性肾病占同期同年龄原发性肾小球疾病比分别为42.8％和17.4％（Х^2=119.058,P＜0.01）.老年组病程、水肿、高血压、血尿素氮、血肌酐、血中IgG、IgA及IgG/IgM比值均高于对照组,而肾小球滤过率、血IgM低于对照组,差异均有统计学意义（P＜0.05）.老年组疾病危险度明显高于对照组,差异有统计学意义（Z=-5.853,P＜0.01）.临床诊断两组均以肾病综合征常见,但老年组肾病综合征较对照组更常见,差异有统计学意义（Х^2=6.825,P=0.033＜0.05）;两组均以Ⅱ期及以下的膜性肾病常见,在病理分期以及临床表现与病理分期间的关系差异无统计学意义（P＞0.05）. 结论 （1）老年组及对照组特发性膜性病男性多于女性;（2）老年患者以Ⅱ期及以下膜性肾病常见,老年患者疾病危险度高;（3）老年患者易发生水肿、高血压及肾功能异常.

Objective To understand the clinical and pathological characteristics of idiopathic membranous nephropathy,and to investigate their relationships in the elderly patients.Methods The clinical and pathological data of idiopathic membranous nephropathy diagnosed by renal biopsy in the recently 10 years in our hospital were retrospectively analyzed and compared.Results Sex composition variable was not significant between elderly and non-elderly groups,with male accounting for 57.4% and 59.2% respectively （P〉0.05）.The ratio of idiopathic membranous nephropathy in primary glomerular disease was higher in the elderly than in non-elderly group （42.8% vs.17.4%,Х^2 =119.058,P〈0.01）.The course of the disease,the occurrence of edema,hypertension,levels of blood urea nitrogen,serum creatinine,blood IgG,IgA and IgG/IgM ratio were higher,while glomerular filtration rate and blood IgM level were lower in elderly group than in non-elderly group （all P〈0.05）.The risk for membranous nephropathy was higher in elderly than in non-elderly group （Z=-5.853,P〈0.01）.Nephrotic syndrome was common in the clinical diagnosis in the two groups,but it was more common in elderly group than in non-elderly group （Х^2 =6.825,P=0.033）.Membranous nephropathy stage Ⅱ was common in the two groups,and there were no significant differences in the pathological stages,clinical manifestations and their relationships between the two groups （all P〉0.05）.Conclusions The risk for idiopathic membranous nephropathy is higher in elderly group than in non-elderly group.Edema,hypertension and renal dysfunction occur more commonly in elderly patients with idiopathic membranous nephropathy.