中老年不典型膜性肾病的临床与病理分析

The clinical and pathological analysis of atypical membranous nephropathy in middle-aged and elderly patients

目的探讨中老年不典型膜性肾病(AMN)的临床与病理特点。方法回顾性分析2015年1月至2020年12月在杭州市中医院行肾穿刺活检的中老年(≥45岁)AMN患者73例和青年(18~44岁)AMN患者30例,分别作为中老年组和青年组,比较两组的临床与病理特点。结果中老年组患者合并高血压、糖尿病、乙肝相关指标阳性的比例及血尿素氮水平均明显高于青年组,eGFR、尿渗透压值均低于青年组,差异有统计学意义(P<0.01)。肾脏组织病理学检查显示,中老年组发生肾小球硬化、肾小管间质慢性病变的程度均重于青年组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄(OR=0.952,P=0.018)、血清白蛋白(OR=1.183,P=0.001)、尿蛋白定量(OR=0.745,P=0.003)和血肌酐(OR=0.956,P=0.009)是影响AMN患者蛋白尿缓解、预后的因素。本组中老年AMN患者治疗6个月的完全缓解率明显低于青年组,差异有统计学意义(P<0.05)。结论中老年AMN患者合并的基础疾病多、肾脏组织病理损害程度重、疾病初期即可伴有肾功能受损,临床缓解率较低。

Objective To explore the clinical and pathological features of atypical membranous nephropathy(AMN)in middle-aged and elderly patients.Methods A retrospective analysis was performed on 73 middle-aged and elderly(45≥years old)AMN patients and 30 young(18~44 years old)AMN patients who underwent renal biopsy in Hangzhou Hospital of Traditional Chinese Medicine from January 2015 to December 2020 and they were divided into the middle and old group and the young group.The clinical and pathological characteristics of the two groups were compared.Results The proportion of patients with hypertension,diabetes,hepatitis B-related indicators and blood urea nitrogen were significantly higher in the middle and old group than in the young group,while eGFR and urine osmotic pressure were lower than in the young group,and the differences were statistically significant(P<0.01).Renal histopathological examination showed that the degree of glomerulosclerosis and chronic tubulointerstitial disease in the middle and old group was higher than that in the young group,with statistical significance(P<0.05).Multivariate logistic regression analysis showed that,age(OR=0.952,P=0.018),serum albumin(OR=1.183,P=0.001),urine protein quantity(OR=0.745,P=0.003)and serum creatinine(OR=0.956,P=0.009)were the factors affecting proteinuria remission and prognosis in AMN patients.In this group,the complete remission rate of middle-aged and elderly AMN patients after 6 months of treatment was significantly lower than that of the young group,and the difference was statistically significant(P<0.05).Conclusion Middle-aged and elderly AMN patients have many complicated basic diseases,severe pathological damage of kidney tissue and renal function impairment at the early stage of disease,and the clinical remission rate is low.