特发性膜性肾病98例临床病理分析

Clinico-pathological features of idiopathic membranous nephropathy in 98 adult cases

目的探讨未经免疫抑制剂治疗的特发性膜性肾病（IMN）的临床及病理特点，分析影响IMN肾功能的危险因素，为临床评估患者病情及治疗提供理论依据。方法对2015年7月至2016年6月经肾组织活检确诊的98例IMN的临床和实验室资料进行回顾性分析。按性别及是否合并肾功能下降分组，分别分析其临床和病理特点。结果男女两组比较，男性患者24h尿蛋白（P=0．033）、血红蛋白（P〈0．001）、血肌酐（P〈0．001）及尿素氮（P〈0．001）明显高于女性患者，而其eGFR（P=0．02）及尿沉渣红细胞（P=0．021）低于女性；肾功能下降组年龄（P〈0．001）、24h尿蛋白（P=0．001）、血肌酐（P〈0．001）及尿素氮（P〈0．001）高于肾功能正常组；行肾脏穿刺活检术前eGFR水平与年龄、24h尿蛋白、尿素氮及收缩压水平呈负相关。IMN病理分期主要以Ⅱ期患者为主，免疫荧光病理检查提示肾小球内免疫球蛋白及补体沉积以IgG、C3为主，分别占100％及79．6％。结论IMN在男性中发病率较高，男性IMN患者在临床实验室指标较女性表现重；年龄、24h尿蛋白、尿素氮、收缩压水平是IMN患者肾功能下降的独立危险因素。

Objective To investigate the clinico-pathological characteristics of idiopathic membranous nephropathy （IMN） without immunosuppressive agents treatment and analyze the risk factors affecting the renal function, provide more evidence for the clinical evaluation of the patientg condition and treatment. Methods From July 2015 to June 2016, the clinical and laboratory data of 98 patients with IMN confirmed by renal biopsy who were analyzed retrospectively. According to gender and renal func- tion, the clinical and pathological characteristics were analyzed. Results According to gender, in the male patients,the urinary protein （P = 0. 033 ）, serum creatinine （P 〈 0. 001 ） and blood urea nitrogen （P 〈 0. 001 ） were higher than those of female ones, in terms of eGFR （P = 0. 02）, hemoglobin （ P 〈 0. 001） and erythrocyte sedimentation （P =0. 021 ） were lower than those of female ones; According to serum creatinine, in the renal dysfunction group, the age （P 〈 0. 001 ）, serum creatinine （P 〈 0. 001 ） and blood urea nitrogen （P 〈 0. 001 ） were higher than those in the normal renal function group ; IMN pathological staging was mainly in stage Ⅱ , Immunofluorescence examination showed that immunoglobulins and complement deposite in glomerulars. IgG, C3, accounting for 100% and 79.6% respectively. The levels of eGFR were negatively correlated with age, 24-hour urinary protein, BUN and SBP. Conclusions The incidence of IMN is higher in men than that in women patients, and the clinical manifestation and laboratory results in men are also more serious than that in the women ones. And the age, urinary protein, BUN and SBP levels are independent risk factors of renal function deterioration.