摘要
目的探讨老年特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床与病理特点,指导该病的临床治疗及预后。方法回顾性分析107例于益都市中心医院确诊为IMN患者的临床与病理特点,其中65例老年IMN及42例青年IMN患者。结果 IMN以肾病综合征为主要临床表现,以水肿为主要首发症状,老年组慢性肾衰竭(chronic renal failure,CRF)、感染、血栓等并发症发生率及血糖(blood glucose,BS)、血压(blood pressure,BP)、心衰指数(heart failure index,HFI)、血肌酐(SCr)、三酰甘油(triglyceride,TG)、胆固醇(total cholesterol,TCHO)、磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体、尿β2微球蛋白(urineβ2-microglobulin,β2-MG)水平均高于青年组(P均<0.05),但估算肾小球滤过率(estimated glomerular filtration rate,eGFR)水平明显低于青年组(P均<0.05),而血尿素氮(BUN)、血红蛋白(hemoglobin,Hb)、白蛋白(albumin,A1b)、凝血酶原时间(prothrombin time,PT)、尿蛋白定量(urine protein quantitative,Upro)及尿N-乙酰-β-D氨基葡萄糖甘酶(NAG)的差异无统计学意义(P>0.05)。IMN患者病理以Ⅰ、Ⅱ期为主。老年组系膜细胞增生、间质纤维化、炎细胞浸润、肾小管萎缩、肾血管硬化程度均明显重于青年组(P<0.05)。2组IgG及补体C3的沉积明显高于IgA、IgM与补体C4、C1q,但组间差异无统计学意义;2组PLA2R沉积浓度具有显著差异(P<0.01)。IMN肾脏病理损伤与BP、SCr、BS、TCHO、TG、PLA2R、Upro、β2-MG水平呈明显正相关,与Alb、eGFR水平呈明显负相关。结论老年IMN患者以肾病综合征为主要临床表现,以水肿为主要首发症状,病理以Ⅰ、Ⅱ期为主,系膜细胞增生、间质纤维化、炎细胞浸润、肾小管萎缩、肾血管硬化程度较重,并发症发生率高。
Objective To investigate the clinical and pathological features of idiopathic membra- nous nephropathy （IMN） in the elderly, to guide the clinical treatment and prognosis of the disease. Methods The clinical and pathological features of 107 patients with IMN who diagnosed in our hospi- tal, 65 elderly patients and 42 young patients , were retrospectively analyzed. Results IMN with ne- phrotic syndrome （NS） as the main clinical manifestations, to edema as the main symptom, the occur- rence rate of chronic renal failure, infection, thrombosis, etc. complications and the levels of blood glucose, blood pressure, heart failure index, serum creatinine triglyceride, cholesterol, phospholipase A2 receptourine antibodies, β2 -microglobulin were higher in elderly patients than that in young group （P〈0. 05）, but the level of estimated glomerular filtration rate was significantly lower than that of the young group （P〈0. 05） ,however there was no statistically significant difference of blood urea ni- trogen.hemoglobin.albumin.prothrombin time.urine protein quantitative and urine NAG enzyme（P〉0. 05）. The mainl pathology of IMN patients was I and II stage. Mesangial cell proliferation, intersti- tial fibrosis, inflammatory cell infiltration, renal tubular atrophy, and the degree of vascular sclerosisin the elderly were significantly more than that in the young group （P〈0. 05）. The deposition of IgG and complement C3 in the two groups was significantly higher than that of IgA, IgM and complement CA, C1 q, but there was no statistically significant difference between the groups;two groups of PLA2R sediment concentration has significant difference（P〈0. 01）. The renal pathologic injury with IMN pa- tients has positive correlation with the level of BP, SCr, BS, TCHO, TG, PLA2R, Upro, β2-MG and negative correlation with the level of Alb, eGFR. Conclusions Elderly patients with IMN with ne phrotic syndrome （NS） as the main clinical manifestations, edema as the main symptom, pathological stage I and II, the proliferation of mesangial cells, fibrosis, inflammatory cell infiltration, tubular at- rophy and interstitial fibrosis, renal vascular sclerosis heavier , complication rate is high.
出处
《临床肾脏病杂志》
2017年第2期90-94,共5页
Journal Of Clinical Nephrology
关键词
特发性膜性肾病
肾脏病理
磷脂酶A2受体
老年人
Idiopathic membranous nephropathy
Nephritic pathology
Phospholipase A2 recep-tor
Old people
