特发性膜性肾病患者的临床特点及不同治疗方式的效果

Clinical characteristics of idiopathic membranous nephropathy and the effect of different treatment methods

目的探讨特发性膜性肾病(Idiopathic membranous nephropathy,IMN)患者的临床流行病学特点及不同治疗方式的效果与影响因素。方法纳入2013年～2015年我院收治的200例IMN患者,64例患者采用保守治疗,设为对照组,136例患者采用免疫抑制治疗,设为观察组,比较两组临床疗效。按治疗效果分为无效组与有效组,调查两组患者性别、年龄、高血压、糖尿病等病历资料,单因素、多因素分析探究影响临床疗效的影响因素。结果观察组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05);对照组疗效单因素分析显示两组血三酰甘油水平差异均有统计学意义(P<0.05),观察组疗效单因素分析显示两组血三酰甘油、血清ALB、总胆固醇、低密度胆固醇(LDL)水平差异均有统计学意义(P<0.05);多因素分析血三酰甘油水平是影响IMN保守治疗效果的独立危险因素,三酰甘油水平、血清ALB是影响免疫抑制治疗的独立危险因素。结论 IMN男性患者较多,主要表现为血尿、大量蛋白尿以及高血Scr等,免疫抑制治疗疗效优于保守治疗,高三酰甘油水平、低血清ALB可影响临床疗效。

Objective To investigate the epidemiological features and therapeutic effect and its risk factors of patients with idiopathic membranous nephropathy(IMN).Methods 200 patients with IMN admitted to our hospital from2013 to 2015 were enrolled into this study with 64 patients received conservative therapy(control group)and 136 patients received immunosuppressive therapy(observation group).Then patients were divided into non-remission group and remission group according to the treatment effect.Furthermore,the baseline data of remission and non remission patients were investigated,including gender,age,hypertension and diabetes.The correlations of their baseline data with efficacy were assessed by singular and multiple factor analysis.Results The average age of the 200 IMN patients was(57.54±4.34)years old.124(62.00%)were male and 76(38.00%)were female.24 hurinary protein quantitation was(3.86±0.34)g and the serum creatinine was(73.67±5.65)μmol/L.69 cases were stageⅠ,86 cases were stageⅡ,32 cases were stageⅢand 13 cases were stageⅣ.Hematuria was found in 122 cases(61%).The total effective rate of treatment in the observation group was significantly higher than that of the control group(62.50%vs 82.35%),and the difference was statistically significant(P<0.05).Univariate analysis showed that the levels of triglyceride of non-remission and remission patients in control group had significant difference(P<0.05),and the levels of triglyceride,ALB,total cholesterol and low density cholesterol of non-remission and remission patients in observation group had statistically significant differences(P<0.05).Multivariate analysis showed that triglyceride level was an independent risk factor influencing the effect of IMN conservative therapy,and the levels of triglyceride and ALB are independent risk factors of immunosuppressive therapy.Conclusion IMN has more male patients,mainly manifested as hematuria,massive proteinuria and high blood Scr.Immunosuppressive therapy is better than conservative treatment.High triglyceride level and low serum ALB can affect the clinical efficacy.