摘要
目的 总结 86例特发性膜性肾病 (IMN)患者早期临床及病理资料特点 ,分析肾脏存活率 ,探讨预后影响因素。方法 回顾性分析 1 983- 2 0 0 1年我院经肾活检证实的 86例IMN患者的临床病理资料特点 ,对其中获得随访的 4 4例 ,以进展至终末期肾衰 (ESRF)或血肌酐浓度 (Scr)增加 1倍 (肾功能恶化 )作为终点判断标准 ,采用Kaplan Meier曲线和COX比例风险模型分别进行预后分析。 结果 86例IMN患者中 ,蛋白尿 >3.5 g/ 2 4h占 5 4 .7%,肾病综合征占 4 4 .2 %,血尿 2 9.1 %(肉眼血尿仅 1例 ) ,高血压 2 3.3%,肾静脉血栓 3.5 %。病理分期以Ⅰ、Ⅱ期为主 ,占 96 .5 %,小管 间质病变程度较轻。病理改变与肾活检前病程、Scr正相关 ,与内生肌酐清除率呈负相关。以发病日为随访起点 ,5年肾脏存活率 96 %,1 0年 6 1 .8%;以肾穿刺日为起点 ,5年肾脏存活率84 .5 %,1 0年 5 5 .6 %。肾活检时的Scr和血胆固醇浓度与IMN预后相关。结论 肾活检时的Scr和血胆固醇浓度可能是预测IMN预后的有用指标。IMN患者应早就诊 ,早穿刺 ,以了解病情指导治疗 ,从而更好地保护肾功能。
Purpose To investigate the clinical and pathological features and their relationships with the prognosis in idiopathic membranous nephropathy(IMN). Methods Baseline data of 86 cases of IMN were extracted at the time of diagnostic renal biopsy and there were 44 cases follow-up.The end points were end-stage renal failure (ESRF) or double baseline value of serum creatinine (deterioration of renal function).Kaplan-Meier curves and COX proportional hazards model were used in the survival analysis. Results Of 86 IMN patients,54.7% had proteinuria of greater than 3.5 g/24 h and 44.2% had nephrotic syndrome.The Kaplan-Meier estimated the renal survival rates were 96% at 5 years and 61.8% at 10 years from onset,while 84.5% at five years and 55.6% at ten years from renal biopsy.The predictors for IMN outcome were serum creatinine level(hazard ratio 1.02,P=0.035) and serum cholesterol level(hazard ratio 1.33, P=0.023). Conclusions Serum creatinine and serum cholesterol can predict deterioration of renal function.Renal biopsy is recommended performing as early as possible.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2005年第2期192-196,208,共6页
Fudan University Journal of Medical Sciences
