20例青年特发性膜性肾病的临床病理特点分析

Clinical and pathological features of young patients with idiopathic membranous nephropathy in 20 cases

目的 探讨青年特发性膜性肾病（IMN）的临床及病理特点.方法 回顾性分析本院2013年1月至2014年12月经肾活检确诊的具有完整临床及病理资料的20例青年（16～44岁）IMN患者,并与同期住院的55例中老年（≥45岁）IMN患者比较,分析其临床及病理特点.结果 青年患者占IMN患者的26.7％.与中老年IMN患者比较,青年患者发病时原发性高血压患者少（P=0.003）,血糖低（P=0.010）;估算的肾小球滤过率（eGFR）、低密度脂蛋白（LDL）水平高（P=0.0 12,P=0.038）;血清T3、T4水平低（P=0.030,P=0.034）;肾组织光镜下肾小球球性硬化比例低（P＜ 0.001）;肾小管间质无病变患者比例高（P=0.018）;小动脉透明变性及小动脉壁增厚比例低（P=0.040,P＜0.001）;免疫球蛋白IgA阳性率低（P=0.008）.肾组织免疫病理、电镜下系膜区致密物沉积比例及其他血清学、尿检指标改变两组差异均无统计学意义.结论 相对中老年IMN患者,青年IMN患者发病时血压、血糖水平较好,肾小球滤过率较高、LDL高,甲状腺功能受影响较明显,光镜下肾小球、间质及血管病变较轻.

Objective To investigate the clinical and pathological features of idiopathic membranous nephropathy （IMN） in young patients.Methods Clinical data of 20 young patients, 16 to 44 years, who were diagnosed as IMN admitted to the Zhejiang Provincial People＆#39;s Hospital from January 2013 to December 2014 were retrospectively analyzed, comparing to 55 mid-aged patients who were diagnosed as IMN during the same period in the hospital.Clinical and pathological features of above mentioned patients were analyzed.Results Young patients with IMN accounted for 26.7% of IMN patients.Compared to mid-aged patients, young patients with IMN had lower proportion of hypertension （P=0.003）, lower blood glucose level （P=0.010）, higher estimated glomerular filtration rate （eGFR） and low-density lipoprotein （LDL） （P=0.012, P=0.038）, and lower levels of T3 and T4 （P=0.030, P=0.034）.Furthermore, there were less sclerosis glomeruli （P〈 0.001）, hyaline change of arteriole （P=0.040） and arteriolar wall thickening （P 〈 0.0001）, lower positive ratios of IgA （P=0.008）,and more without renal tubulointerstitial lesions （P=0.018） in young patients.There were no statistically significant differences between these two groups in other index.Conclusions Compared to mid-aged patients, young patients with IMN have better blood pressure and blood glucose level, higher glomerular filtration rate and LDL.Moreover, thyroid function is significantly affected, meanwhile the lesions of glomerular, interstitial and vascular are mild in young patients.