特发性膜性肾病临床病理分析

The analysis on features of clinical pathology in patients with membranous nephropathy

目的阐述特发性膜性肾病(idiopathic membranous nephcopathy,IMN)患者临床病理特点。方法选取2017年12月-2019年4月于蚌埠医学院第一附属医院住院并经肾穿刺活检明确诊断为IMN的患者156例作为研究对象,对其临床及病理资料进行分析。结果156例IMN患者肾穿刺前病程长短不一,年龄分布于各年龄段,男性较女性偏多,以中老年男性患者居多。95%患者以水肿为初发就诊原因;所有就诊病人均有蛋白尿,但其严重程度不一,达到肾病综合征标准占64%;85.9%患者有镜下血尿;94%的患者有高脂血症;16.7%患者同时合并有高血压。男性患者出现低蛋白血症、大量蛋白尿,表现为肾病综合征较多,肾损伤明显,差异有统计学意义(P<0.05)。随着年龄的增长,肾小球及肾小管的病变亦加重,差异有统计学意义(P<0.05);IMN分期以Ⅰ、Ⅱ期为主,占92.3%,不同病理分期的患者在病程、24hutp,血脂,血尿及免疫球蛋白等方面比较,差异无统计学意义(P>0.05);各年龄组比较,免疫球蛋白的沉积差异无明显差异。结论特发性膜性肾病好发于中老年男性,临床表现以水肿初发,均有蛋白尿,以肾病综合征表现为主,病理类型以Ⅰ、Ⅱ期为主,对于中老年患者,临床表现为肾病综合征同时伴高血压及肾功能不全,应完善肾穿刺活检明确病理,积极治疗,延缓肾脏病进展。

Objective To elucidate the clinicopathological characteristics of idiopathic membranous nephropathy(IMN)patients.Methods From December 2017 to April 2019,156 patients hospitalized in the first affiliated hospital of Bengbu medical college and diagnosed as IMN by renal puncture biopsy were selected as study subjects.Their clinical and pathological data were analyzed.Results The course of disease in IMN patients was different before renal puncture,it occurred in patients of all age range,there were more males than females,and most of them were middle-aged and elderly male patients.95%of the patients had their first visit due to edema.All the patients had albuminuria,but the severity was different,64%of the patients met the criteria of nephrotic syndrome.Endoscopic hematuria occurred in 85.9%of patients.94%of the patients had hyperlipidemia,and 16.7%of the patients had hypertension at the same time.The male patients had hypoalbuminemia and a lot of albuminuria,which presented nephrotic syndrome and obvious renal injury,and there was significant difference between the two groups(P<0.05).With the increase of age,the lesions of glomeruli and tubules were also aggravated,and the difference was statistically significant(P<0.05).Most of the IMN were in stageⅠand stageⅡ,accounting for 92.3%.There was no significant difference in the course of disease,24 hutp,blood lipid,hematuria and immunoglobulin among the patients with different pathological stages(P>0.05).There was no significant difference in immunoglobulin deposition among different age groups(P>0.05).Conclusions Idiopathic membranous nephropathy is prone to occur in middle-aged and elderly men.The clinical manifestations were primary edema,all of which had albuminuria,mainly nephrotic syndrome,and the pathological types were stageⅠand stageⅡ.In middle-aged and elderly patients,the clinical manifestations are nephrotic syndrome accompanied by hypertension and renal insufficiency.Renal puncture biopsy should be improved to clarify the pathology,actively treat and delay the progress of kidney disease.