原发性膜性肾病不同分期患者的临床特点及病理特征

Clinical and pathological characteristics of primary membranous nephropathy at different stages

目的分析84例原发性膜性肾病不同分期患者的临床特点及病理特征。方法抽取2018年1月至2020年6月于焦作市人民医院行肾组织活检并确诊的原发性膜性肾病患者84例,按肾脏病理结果分期不同分为Ⅰ期膜性肾病11例、Ⅱ期膜性肾病55例、Ⅲ期膜性肾病18例三组。采用描述性研究,普查所有患者的临床及病理资料,记录患者的一般情况、临床资料及病理资料。结果84例原发性膜性肾病患者中,男51例,女33例,男∶女为1.55∶1,原发性膜性肾病不同分期男性均多于女性,且以Ⅱ期膜性肾病居多(占65.48%)。各期均多表现为大量蛋白尿。主要病理特点:免疫荧光结果显示,肾小球内以IgG、C3、IgM沉积为主[阳性率分别为100%(84/84)、79.76%(67/84)、69.05%(58/84)],均为颗粒样沉积,沉积部位大部分沿毛细血管壁。光镜下肾小球硬化随着分期进展,比例逐渐增高,Ⅰ期、Ⅱ期、Ⅲ期分别为27.27%(3/11)、40.00%(22/55)、44.44%(8/18)。肾小管上皮细胞存在空泡及颗粒变性、蛋白管型及灶状扩张。各期均存在肾间质灶状淋巴及单核细胞浸润伴纤维化、灶状水肿及泡沫细胞。小动脉存在不同程度的管壁增厚、管腔狭窄及玻璃样变。结论原发性膜性肾病不同分期患者的临床表现和病理特征均具有自身特点,临床诊断中应予以关注。

Objective To analyze the clinical and pathological features of 84 patients with primary membranous nephropathy at different stages.Methods A total of 84 patients with primary membranous nephropathy treated in People’s Hospital of Jiaozuo from January 2018 to June 2020 were selected.According to the stages of renal pathological results,they were divided into 11 cases of stage I membranous nephropathy,55 cases of stageⅡmembranous nephropathy and 18 cases of stageⅢmembranous nephropathy.Descriptive study was used,the clinical and pathological data of all patients were collected.The general information,clinical data,and pathological data were recorded.Results There were 51 males and 33 females in 84 patients with primary membranous nephropathy.The ratio of male to female was 1.55∶1.There were more males than females among patients with primary membranous nephropathy at every stage,and most of patients were stageⅡmembranous nephropathy(65.48%).The patients with membranous nephropathy at different stages showed massive proteinuria.Immunofluorescence results showed that,most of patients had IgG deposit(100%,84/84),C3 deposit(79.76%,67/84),and IgM deposit(69.05%,58/84)in glomeruli,which were all granular deposit,mainly deposited along the wall of the capillary.Under light microscope,the proportion of glomerulosclerosis gradually increased with increase in stages,and the proportions of stageⅠ,ⅡandⅢwere 27.27%(3/11),40.00%(22/55)and 44.44%(8/18),respectively.There were vacuole and granular degeneration,tubular protein and focal dilatation in renal tubular epithelial cells.Renal interstitial stromal lymph nodes and mononuclear cells were infiltrated with fibrosis,focal edema and foam cells in patients at every all stages.There were different degrees of wall thickening,Lumen stenosis and hyaline degeneration in arterioles.Conclusions The clinical and pathological features of primary membranous nephropathy at different stages have different characteristics,which should be paid attention to in clinical diagnosis.