老年人特发性膜性肾病临床病理特点分析

Clinicopathological characteristics of idiopathic membranous nephropathy in elderly patients

目的比较老年与非老年特发性膜性肾病(IMN)患者的临床病理差异.方法回顾性选取2017年1月至2021年8在北京怀柔医院、北京中医院、昌平区中医院、诊断为IMN的临床病理资料,按年龄分为老年组(≥65岁)与非老年组(<65岁),比较两组之间的临床病理差异.结果共207例IMN患者纳入研究,男女比例1.7∶1.0.老年组56例,年龄(68.2±3.1)岁,非老年组151例,年龄(48.2土6.2)岁.老年组发病到肾活检时间长,合并肾功能不全及高血压的比例高(均P<0.05).老年组比非老年组eGFR及血清白蛋白低,血清胆固醇高、低密度脂蛋白胆固醇高(均P<0.05).肾脏病理提示老年组肾小球硬化、肾小管萎缩及间质纤维化的比例比非老年组高(均P<0.05).肾小球抗磷脂酶A2受体(PLA2R)抗原染色,两组患者阳性率分别90.6%(29/32)及91.0%(111/122),两组比较差异无统计学意义(P>0.05).IgG亚类分型均以IgG4沉积为主,老年组93.8%(30/32),非老年组94.3%(115/122),两组比较差异无统计学意义(P>0.05).结论老年IMN患者发生肾功能不全及高血压比例高,肾脏病理呈慢性化表现比例高.老年IMN患者肾小球内致病抗原沉积与非老年组相似,提示在发病机制上两组不存在区别.两组患者表现出来的临床病理的差异可能与年龄及并发症有关.

Objective To compare the clinicopathological differences between elderly and non-elderly patients with idiopathic membranous nephropathy(IMN).Methods Patients diagnosed with IMN via renal biopsy at Beijing Huairou Hospital,Beijing Changping Hospital of Traditional Chinese Medicine,and Beijing Hospital of Traditional Chinese Medicine from January 2017 to August 2021 were retrospectively enrolled.They were classified into the elderly group(≥65 years)and the non-elderly group(<65 years),and the clinicopathological differences between the two groups were compared.Results A total of 207 IMN patients were included in the study,with a male to female ratio of 1.7∶1.0.There were 56 patients in the elderly group,aged(68.2±3.1)years,and 151 patients in the non-elderly group,aged(48.2±6.2)years.Compared with the non-elderly group,the elderly group had a longer time from onset to renal biopsy and a higher proportion of patients with renal insufficiency and hypertension(P<0.05).The elderly group had a lower eGFR,lower serum albumin,higher serum cholesterol,and higher low-density lipoprotein than the non-elderly group(P<0.05).The proportions of patients with glomerulosclerosis,renal tubular atrophy,and interstitial fibrosis in the elderly group were higher than in the non-elderly group(P<0.05).The positive rates of glomerular PLA2R antigen staining in the two groups were 90.6%(29/32)and 91.0%(111/122),respectively,and there was no statistically significant difference between the two groups.IgG4 deposition represented the most common IgG subtype,with 93.8%(30/32)in the elderly group and 94.3%(115/122)in the non-elderly group.There was no statistical significance between the two groups(P>0.05).Conclusions Compared with non-elderly IMN patients,a higher proportion of elderly IMN patients has renal insufficiency,hypertension and chronic renal pathology.The glomerular deposition of pathogenic antigens in elderly IMN patients was similar to that in non-elderly IMN patients,suggesting no difference in pathogenesis between the two groups.The clinicopathological differences between the two groups may be related to age and complications.