摘要
目的探讨不同年龄的特发性膜性肾病（idiopathic membranous nephropathy，IMN）患者临床病理特点及其相关性。方法回顾性分析2010年5月至2015年5月在新疆维吾尔自治区人民医院肾病科住院，经肾活检病理诊断为IMN患者89例的临床及病理资料，年龄18-76岁，平均年龄（45．2±13．1）岁，病程7d～84个月，平均病程（12．4±18．2）个月，根据不同年龄进行分组，年龄小于20岁（小于20岁组）4例，年龄20-39岁（20-39岁组）22例，年龄40-59岁（40-59岁组）52例，年龄60岁以上（60岁以上组）11例。比较各组间的临床指标，病理分期、免疫荧光检查等。结果89例IMN患者发病年龄以40-59岁组为最高峰（52例，占58．4％）；临床表现中以肾病综合征最多见（66例，占74．2％），其次浮肿（63例，占70．8％）。不同年龄组的IMN患者临床指标显示收缩压、舒张压、总胆固醇、血肌酐、尿酸、24h尿蛋白定量与年龄之间具有统计学意义（P〈O．05），尤其是40～59岁组和60岁以上组患者高血压、高血脂明显高于小于20岁组和20-39岁组。病理资料显示，40～59岁组及60岁以上组患者肾脏病理指标中肾小管一间质损害程度及动脉壁增厚变性较小于20岁组和20-39岁组严重，病理分期以Ⅲ期最常见（34例，占38．2％）、其次Ⅱ期（20例，占22．5％）；免疫荧光以IgG沉积最多见（86例，占96．6％）、其次为C3沉积（55例，占61．8％）。结论IMN患者以40岁以上中老年男性多见，以肾病综合征为主要临床表现；40岁以上患者收缩压、舒张压、总胆固醇、血肌酐、尿酸，肾小管-间质损害程度及动脉壁增厚变性较严重，故对IMN患者应早期行肾穿刺活检，以明确疾病的病理类型及疾病进展情况，对实施治疗方案及延缓疾病进展有十分重要的意义。
Objective To explore the clinicopathological features of idiopathic membranous nephropathy （IMN） at different ages. Methods The clinicopathological data of 89 patients with IMN diagnosed by renal biopsy from May 2015 to May 2010 in the Xinjiang Uygur Autonomous Region People＇s Hospital were retrospectively analyzed. The patients aged 18-76 years old （mean 45.2 ± 13.1）, and the course of disease was 7 days-84 months （mean 12. 4± 18.2 months）. All patients were divided into four groups according to their age： less than 20 years old group （n = 4）, 20-39 years old group （n = 22）, 40-59 years old group （n = 40）, over 60 years old group （n = 11）. The clinical indexes, pathological typing and immunofluorescenee examinations were analyzed. Results The highest peak of IMN was 40 to 59 years old （52 cases, 58.4%）. The clinical manifestations of the nephrotic syndrome were the most （66 cases, 74. 2%） ,followed by edema （63 cases, 70. 8%）. The clinical data of IMN patients at different ages showed significant difference （P〈0. 05） in systolic blood pressure, diastolic blood pressure, total cholesterol, serum creatinine, uric acid, and 24-h urine protein. The incidence of hy pertension and hyperlipidemia was significantly higher in 40-59 years old group and over 60 years old group than in less than 20 years old group. The renal pathological changes of renal tubular-interstitial damage and arterial wall thickening in 40-59 years old group and over 60 years old group were more se- rious than in less than 20 years old group and 20-39 years old group. The pathological staging was the most common in stage Ⅲ （34 cases, 38. 2%）,and the stage Ⅱ （20 cases, 22. 5% ）. Immunofluorescence staining revealed that IgG deposition was most seen （86 cases, 96. 6%） ,followed by （23 deposition （55 cases, 61.8%）. Conclusions IMN is commonly seen in mid-aged males of over 40 years old. The main manifestation is nephrotic syndrome. In IMN patients over 40 years old, systolic blood pressure, diastolic blood pressure, total cholesterol, serum creatinine, and uric acid are higher, and the renal interstitial damage and arterial wall thickening are more serious. Early renal biopsy is necessary for IMN patients in order to clarify the pathological type and the progress of the disease. It has very important significance to carry out the treatment plan and delay the disease progression.
出处
《临床肾脏病杂志》
2015年第10期594-598,共5页
Journal Of Clinical Nephrology
基金
新疆维吾尔自治区“十二五”重大科技专项(NO.201230119)
新疆维吾尔自治区科技援疆项目(NO.2013911114)
新疆维吾尔自治区科技成果转化专项资金项目(NO.201454135)
关键词
特发性膜性肾病
肾活检
年龄
临床病理
Idiopathic membranous nephropathy
Renal biopsy
Age
Clinicopathological
