特发性膜性肾病患者临床与肾脏病理表现的相关因素分析

Analysis of related factors of clinical and renal pathological characteristics in patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病患者(idiopathic membranous nephropathy,IMN)的临床及病理特征及对肾小球滤过率的影响。方法纳入2017年1月至2018年12月在新疆维吾尔自治区人民医院确诊为IMN的119例患者,根据估算的肾小球滤过率(eGFR)将患者分为eGFR正常组58例[eGFR≥90 mL·min^-1·(1.73 m^ 2)-1]和eGFR下降组61例[eGFR<90 mL·min^-1·(1.73 m ^2)^-1],收集患者的临床及病理资料并进行对比分析。结果在临床资料方面,eGFR下降组患者的年龄、高血压患者比例、血肌酐、尿素氮显著高于eGFR正常组(P<0.05),血清白蛋白、血清总蛋白水平显著低于eGFR正常组(P<0.05);在肾脏病理方面,eGFR下降组患者的肾小球硬化、肾小管萎缩、肾间质纤维化、间质炎性细胞浸润、小动脉增厚的比例显著高于eGFR正常组(P<0.05)。Logistic回归分析表明高龄、肾间质炎性细胞浸润是IMN患者eGFR下降的独立危险因素,高血清白蛋白水平是IMN患者eGFR下降的保护因素。结论对于IMN患者应积极采取改善血清白蛋白水平、控制肾间质炎性细胞浸润等办法,保护患者肾功能,延缓疾病进展。

Objective To study the clinical and pathological characteristics of idiopathic membranous nephropathy(IMN)and their influence on glomerular filtration rate.Methods A total of 119 patients with IMN diagnosed in Xinjiang Uygur Autonomous Region People’s Hospital from January 2017 to December 2018 were enrolled.According to the estimated glomerular filtration rate(eGFR),the patients were divided into normal renal function group[58 cases,eGFR≥90 mL·min^-1·(1.73 m ^2)-1]and declined renal function group[61 cases,eGFR<90 mL·min^-1·(1.73 m^ 2)-1].The general data,clinical and pathological data of the patients were compared and analyzed.Results With respect to clinical data,the age,hypertension patient proportion,serum creatinine and urea nitrogen of the patients in the declined renal function group(declined eGFR)were significantly higher than those in the normal group(P<0.05),and the serum albumin and serum total protein levels were significantly lower than those in the normal group(P<0.05).With respect to real pathology,the rates of glomerulosclerosis,tubular atrophy,renal interstitial fibrosis,interstitial inflammatory cell infiltration and thickened small arteryin the declined renal function group were significantly higher than those in the normal renal function group(P<0.05).Logistic regression analysis showed that age,serum albumin level and renal interstitial inflammatory cell infiltration were independent risk factors for declined eGFR in IMN patients;and increased serum albumin level was a protective factor of declined eGFR.Conclusions For IMN patients,the renal function should be improved by improving the level of serum albumin and controlling the infiltration of renal interstitial inflammatory cells,so as to delay the progression of the disease.