摘要
目的探讨特发性膜性肾病伴肾小管间质损伤的临床表现和病理特点。方法回顾性分析笔者医院自2010年9月~2016年12月经肾穿刺活检确诊并具有较完整临床资料的329例特发性膜性肾病患者,其中根据肾小管间质损伤程度分为4组,0级(52例)、Ⅰ级(246例)、Ⅱ级(22例)、Ⅲ级(9例),各组两两比较,分析其临床及病理特点,并对有统计学意义的指标进行多因素有序Logistic回归分析。结果伴肾小管间质损伤的特发性膜性肾病占特发性膜性肾病的84.2%,与0级相比,Ⅰ、Ⅱ、Ⅲ级男性患者比例较高、发病年龄较大(P<0.05);各等级高血压病史的差异均有统计学意义(P=0.000);与0级比较,Ⅱ、Ⅲ级病程更长(P<0.05),Alb、e GFR水平较低(P<0.05),Scr、BUN、24h尿蛋白水平更高(P<0.05);Ⅰ、Ⅱ、Ⅲ级肾小血管病变所占比例较0级更高(P均<0.005);病理分期以Ⅱ期为主,多因素分析提示年龄、高血压病史、病程、Scr及肾小血管病变是特发性膜性肾病肾小管间质损伤的独立危险因素。结论伴肾小管间质损伤的特发性膜性肾病患者的临床表现更重,病理特点表现在肾小血管病变更显著,病理分级差异无统计学意义。多因素分析结果显示发病年龄、高血压病史、病程及肾小血管病变为肾小管间质损伤的独立危险因素,血肌酐水平可间接反映肾小管间质损伤的程度。
Objective To investigate the clinical manifestation and pathological features of idiopathic membranous nephropathy with renal tubule-interstitial damage( TID). Methods Totally 329 patients who were treated and diagnosed as idiopathic membranous nephropathy( IMN) by renal biopsy in Guangdong Provincial Hospital of Traditional Chinese Medicine from September 2010 to December2016 were included in the retrospective research. According to the degree of tubule-interstitial damage,they were divided into 4 groups,grade 0( 52 patients),grade Ⅰ( 246 patients),grade Ⅱ( 22 patients) and grade Ⅲ( 9 patients). The clinical and pathological characteristics were analyzed. Multivariate logistic regression analysis was used to analyze the influence factors. Results The incidence rate of TID in 329 IMN patients was 84. 2%. Compared with grade 0,grade Ⅱ and Ⅲ had more male patient,an older average age,longer course of disease and more higher proportion of history of hypertension. There were significant differences in Alb,e GFR,Scr,BUN and24 h urinary protein between grade 0,Ⅰ to grade Ⅱ,Ⅲ( P〈0.05,respectively). The group with TID which pathologic stage was mainly in stage Ⅱ,showed an higher renal small vessel disease. Multivariate logistic regression analysis showed that age,hypertension,course of disease,Scr and renal small vessel disease were independent risk factors of IMN-TID. Conclusion IMN patients with TID had more severe clinical manifestations. The pathological features were significant in renal small vessel disease. There was no significant difference in pathological grade. The age and hypertension history,course of disease and renal small vessel disease were independent risk factors of IMN-TID. Scr levels can indirectly reflect the degree of TID.
作者
秦美君
李虎才
王立新
Qin Meijun;Li Hucai;Wang Lixin(Guangdong Provincial Hospital of Chinese Medicine,Guangdong 510120,China)
出处
《医学研究杂志》
2018年第6期63-68,共6页
Journal of Medical Research
基金
国家中医药管理局行业专项基金资助项目(2015KT1016)
关键词
特发性膜性肾病
肾小管间质损伤
临床
病理
Idiopathic membranous nephropathy
Tubule - interstitial injury
Clinical
Pathology