成人特发性膜性肾病66例

Clinicopathological features and therapeutic evaluation of idiopathic membranous nephropathy in 66 adult cases

目的了解成人特发性膜性肾病(IMN)的临床表现与病理特点,探讨其治疗方案和治疗效果。方法收集安徽省立医院2013年1月至2015年6月经肾活检确诊的66例IMN患者,观察其临床特征和病理改变特点,并总结不同方案的治疗效果和预后。结果 66例IMN患者,男34例,女32例,起病年龄平均(47.0±15.4)岁,其中以40~59岁居多(47.0%),临床主要表现为肾病综合征56例(84.9%),慢性肾小球肾炎10例(15.1%),血尿13例(22.7%),高血压21例(31.8%),完全缓解(CR)26例(39.4%),部分缓解(PR)19例(28.8%),缓解率达68.2%。随年龄增长,IMN患者血清白蛋白(ALB)浓度低、血胆固醇水平高、肾小球滤过率(e GFR)低、高血压更常见、肾小管间质病变重、肾小血管病变发生率高,均差异有统计学意义(P<0.05)。与女性比较,男性患者血肌酐(SCr)和尿素氮(BUN)高、24 h尿蛋白定量(24 h Upro)多,差异有统计学意义(P<0.01)。不同性别、不同年龄组和不同治疗方案的IMN患者总体治疗缓解率差异无统计学意义。结论 IMN中以40~59岁的男性患者多见,临床主要表现为肾病综合征,年龄大的患者血清ALB和e GFR水平更低、高血压发生率高、肾脏病理损害更显著;目前IMN临床治疗主要仍是激素联合环磷酰胺或其他免疫抑制剂,但差异无统计学意义。

Objective To investigate the Clinicopathological features and explore the treatment of idiopathic membranous nephropathy（IMN） in 66 adult cases. Methods A number of 66 patients of biopsy-proven IMN in the Anhui Provincial Hospital 2013 to June2015 were involved. Data were retrospectively analyzed. Results Among the 66 patients with IMN,including 34 males and 32 females,the mean age at onset was（47. 0 ± 15. 4） years. The major clinical manifestations were including nephritic syndrome in 56 cases（84. 9 %） and chronic glomerulonephritis in 10 cases（15. 1%）. Thirteen patients had hematuria（22. 7%）,21（31. 8%） had hypertension. Twenty-six（39. 4%） of them received complete remission and nineteen（28. 8%） partial remission,the rate of remission was 68. 2%. Age has positive correlation with the level of serum cholesterol and the incidence of hypertension（P〈0. 05）. Age also had negative correlation with the level of serum albumin and estimated glomerular filtration rate（e GFR）（P〈0. 05）. Older patients had more severe tubulointerstitial lesions and higher incidence of renal vascular lesions（P〈0. 05）. Compared with the female patients,male patients had higher level of serum creatinine and blood urea nitrogen,more urine protein quantitation（P 〈0. 01）,with were no significant difference in the rate of remission between the diffetent age,different gender and different treatment groups. Conclusions IMN often occurs in the 40-59 years old male patients,the major presenting feature was nephritic syndrome. Elderly patients had lower e GFR,higher incidence of hypertension and heavier renal pathological lesions. IMN therapy at present was mainly prednisone plus cyclophosphamide or other immunosuppressor,with no significant difference in remission rate.