不同分期特发性膜性肾病的临床病理特点和治疗体会

Clinicopathological characteristics and treatment strategies of idiopathic membranous nephropathy of different stages

目的分析特发性膜性肾病患者的临床病理特点,总结治疗体会。方法收集2011年7月至2014年7月收治的符合纳入标准的94例特发性膜性肾病的临床病理资料,所有患者均经肾脏穿刺活检确诊,并采用Ehrenreich-Churg膜性肾病分期标准分期,对其临床病理特点及治疗效果进行分析和总结。结果入组特发性膜性肾病患者患病年龄>30岁者80例(85.1%),随分期增加年龄呈上升趋势;病程>6月者41例(43.6%),随分期增加病程呈延长趋势;临床表现为肾病综合征者55例(58.5%),镜下血尿29例(30.9%),高血压27例(28.7%),其中高血压发生随病理分期增加呈上升趋势。治疗有效率按Ⅰ期(64.1%)、Ⅱ期(54.1%)、Ⅲ期(27.8%)依次降低,差异有统计学意义(P<0.05)。单用激素治疗者:Ⅰ期治疗前后尿蛋白定量差异有统计学意义(P<0.05);Ⅱ期治疗后尿蛋白定量有下降趋势,但差异无统计学意义(P>0.05);Ⅲ期治疗后尿蛋白定量无降低趋势(P>0.05)。激素联合细胞毒药物治疗者:Ⅰ期和Ⅱ期治疗前后尿蛋白定量差异均有统计学意义(P均<0.05),Ⅲ期治疗后尿蛋白定量有降低趋势,但与治疗前比较差异无统计学意义(P>0.05)。结论特发性膜性肾病随分期增加,年龄、病程、高血压发生呈上升趋势,激素联合细胞毒药物治疗效果优于单用激素治疗。

Objective To analyze and summarize the clinicopathological characteristics and the treatment experience of idiopathic membranous nephropathy. Method The clinical and pathological data of 94 patients with idiopathic membranous nephropathy received and cured from July 2011 to July 2014 were collected. All patients were diagnosed by renal needle biopsy and the pathologic staging was made by Ehrenreich-Churg staging criteria. The clinical and pathological characters and efficacy were analyzed. Results The patients over 30 years of age accounted for 80. 1%（ 80 /94）,and the age had a rising trend with the increase of pathological stage. The courses of disease of 41 patients（ 43. 6%） were more than 6months,and the courses of the disease had a prolonged trend with the increase of stage. There were 55 patients（ 58. 5%）with clinical manifestations of nephrotic syndrome,29（ 30. 9%） with microscopic hematuria,27（ 28. 7%） with hypertension. The incidence of hypertension had a upward trend with the increase of pathological stage. The effective rates were decreased with the increase of stage Ⅰ（ 64. 1%）,stageⅡ（ 54. 1%） and stage Ⅲ（ 27. 8%）,and its difference was significant（ P 0. 05）. For the efficacy of glucocorticoids alone,there was significant difference in urinary protein quantification before and after treatment for stageⅠpatients（ P 0. 05）; but no statistical difference in urinary protein quantification before and after treatment for stageⅡpatients（ P 0. 05）,even though it showed downward trend after treatment; while there was no down trend in urinary protein quantification after treatment for stage Ⅲ patients. For the efficacy of glucocorticoids combined with cytotoxic drugs,there were significant differences in urinary protein quantification before and after treatment for stageⅠandⅡpatients（ all P 0. 05）; but no statistical difference in urinary protein quantification before and after treatment for stage Ⅲ patients（ P 0. 05）,even though it showed downward trend after treatment. Conclusions The incidence of hypertension in idiopathic membranous nephropathy patients shows an upward trend with the increase of pathologic staging,age and courses of disease. The efficacy of glucocorticoids combined with cytotoxic drugs is superior to glucocorticoids alone.