单中心成人特发性膜性肾病的临床病理特征及预后分析

A mono-center clinical study on clinical pathological features and prognosis of adult idiopathic membranous nephropathy

目的分析成人特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者的临床病理特征及预后相关因素,为临床诊断提供思路。方法对2015年1月至2017年12月在昆明医科大学第二附属医院肾内科行肾脏穿刺活检确诊为IMN的83例患者的临床及病理资料进行回顾性分析,并以eGFR<30 mL·min^(-1)·(1.73 m^2)^(-1)为随访终点,分析患者的随访资料。结果 83例IMN患者中,男性55例(66.26%),女性28例(33.73%);平均年龄(50.9±12.7)岁,≥30岁者占91.57%;病理类型中以Ⅰ、Ⅱ期为主,占83.13%。与女性患者相比,男性患者年龄偏大,血肌酐、24 h尿蛋白定量较高,肾小管间质损伤更重,肾小球滤过率及血清白蛋白较低(P<0.05)。与非老年患者相比,老年患者的男性比例、24 h尿蛋白增加,肾功能明显下降,肾小管间质损伤明显加重(P<0.05)。不同病理分期的IMN患者在临床表现方面无显著性差异(P>0.05)。经过12～24个月随访,有12例患者进展至eGFR<30 mL·min^(-1)·(1.73 m^2)^(-1),肾功能进展者较肾功能稳定者在平均动脉压、临床表现为肾病综合征的比例、eGFR、24 h尿蛋白定量及肾小管间质损害方面差异有统计学意义(P<0.05)。结论老年、男性、高血压、大量蛋白尿的患者更易出现肾功能下降和肾小管间质损伤加重,且存在上述因素的IMN患者预后较差,故应尽早明确诊断,并给予个体化的干预治疗。

Objective To analyze clinical pathological features and prognosis-related factors in patients with adult idiopathic membranous nephropathy(IMN),in order to provide new ideas for clinical diagnosis.Methods Retrospective analysis was performed on the clinical and pathological data of 83 patients diagnosed with IMN by renal puncture biopsy in the department of nephrology,the Second Hospital Affiliated to Kunming Medical University from January 2015 to December 2017,and eGFR<30 mL·min^-1·(1.73 m^2)^-1 was used as the end point of follow-up to analyze the follow-up data of the patients.Results Among the 83 IMN patients,55 ones(66.26%)were males and 28 ones(33.73%)were females,and the ones with an age≥30 accounted for 91.57%,with an average age of 50.9±12.7.For pathological types,stageⅠandⅡperiod were predominant,accounting for 83.13%.Compared with the female patients,the male ones had older ages,higher levels of serum creatinine and 24-hour urinary protein,more severe renal tubular interstitial damage,and lower glomerular filtration rate and serum albumin(P<0.05).Compared to the non-senile patients,the senile ones had increased male proportion and 24-hour urinary protein,notably reduced renal function,and aggravated renal tubulointerstitium damage(P<0.05).IMN patients clinical manifestation there was no statistically significant difference between IMN patients at different pathological stages(P>0.05).After the follow-up of 12~24 months,12 patients progressed to show eGFR<30 mL·min^-1·(1.73 m^2)^-1.The differences between the patients with progressed real damage and those with stable renal functions were of statistical significance in average artery pressure,and other clinical manifestations of nephrotic syndrome proportion,eGFR,24 hours urinary protein and renal tubulointerstitium damage(P<0.05).Conclusions Those senile male patients with hypertension and higher urinary protein level are prone to experience decreased renal functions and aggravated renal tubular interstitial damage,and the IMN patients with the above factors may have poor prognosis.Therefore,the patients should be diagnosed definitely and intervened medically in an individualized manner.