特发性膜性肾病临床、病理特点及M型磷脂酶A2受体表达的相关分析  

The features and correlation analysis of clinico-pathological and expression of PLA2R in idiopathic membranous nephropathy

作　　者：刘晓斌[1] 张秋花[1] 陈勇[1] 刘少军[2] 刘斌[1] 张志坚[1] 张悦[1] 胡志刚[1] 黄飚[3] 孙铸兴[1] 王凉[1] 

机构地区：[1]南京医科大学附属无锡人民医院肾内科,江苏省无锡市214000 [2]复旦大学附属上海华山医院肾内科,上海市200040 [3]江苏省原子医学研究所,214063

出　　处：《实用医学杂志》2017年第15期2520-2524,共5页The Journal of Practical Medicine

基　　金：江苏省临床医学科技专项(编号:BL2014022)

摘　　要：目的总结特发性膜性肾病(IMN)的临床、病理及M型磷脂酶A2受体(PLA2R)表达的特点。方法回顾性分析2008年7月至2015年2月在无锡市人民医院肾内科住院并经肾穿刺活检确诊为IMN的244例患者的临床、病理及PLA2R表达的特点。结果 244例IMN患者平均发病年龄(54.07±15.22)岁,男130例,女114例,高血压比例44.3%,肾病综合征比例62.7%。男性与女性相比,蛋白尿程度更高、估算的肾小球滤过率(e GFR)更低(P<0.05)。蛋白尿4~8 g组与>8 g组较<4 g组患者胆固醇更高、收缩压及舒张压更高、e GFR更低、间质小管病变更重(P<0.05)。肾脏病理分期以Ⅰ期、Ⅱ期为主(98%),Ⅱ期与Ⅰ期、Ⅰ~Ⅱ期患者比较,肾间质小管病变更重、e GFR更低(P<0.05)。肾组织中PLA2R阳性率为84.3%,PLA2R阳性较阴性患者的e GFR更低、肾间质小管病变更重(P<0.05)。多元相关及回归分析发现,肾间质小管病变(B=-7.253)、高血压比例(B=-10.726)、总胆固醇(B=-2.077)与e GFR呈负相关(P<0.01,r2=0.470)。结论 IMN患者中的男性、尿蛋白量多、肾脏病理分期高、PLA2R阳性者,肾间质小管病变严重、肾功能受损多见,需要给予更加积极的干预治疗。Objective To investigate the features and correlation analysis of clinico-pathological and expression of phospholipase A2 receptor(PLA2R)in idiopathic membranous nephropathy.Methods A number of 244 patients of IMN proved by renal biopsy were recruited in Wuxi People′s Hospital from July 2008 to February 2015.Data were restrospectively collected.Results In the 244 IMN patients(mean age 54.07±15.22 years,130males and 114 females),44.3% had hypertension and 62.7% had nephrotic syndrome.Compared with female patients,male patients had more severe proteinuria and lower e GFR(P<0.05).Compared with the group of proteinuria<4 g/24 h,the groups of proteinuria 4~8 g/24 h and>8 g/24 h had higher level of cholesterol and blood pressure,lower e GFR and more severe tubulointerstitial lesions(P<0.05).Pathological stage Ⅰ and Ⅱ accounted for 98%,and there were more severe tubulointerstitial lesions and lower e GFR in the patients of stageⅡthan that in the patients of stage Ⅰ and Ⅰ~Ⅱ(P<0.05).The positive rate of PLA2R accounted for 84.3%.Lower e GFR and more severe tubulointerstitial lesions were found in PLA2R-positive patients than those in PLA2R-negative patients(P<0.05).Multiple regression analysis showed that tubulointerstitial lesions(B=-7.253),hypertension ratio(B=-10.726)and the level of cholesterol(B=-2.077)had negative correlations with e GFR(P<0.01,R2=0.470).Conclusions IMN patients of male gender,grave proteinuria,high pathological stage and positive PLA2R should be treated more actively,since severe tubulointerstitial lesions and kidney injury were more common in those patients.

关 键 词：特发性膜性肾病 肾病综合征 肾脏病理 M型磷脂酶A2受体 

分 类 号：R692[医药卫生—泌尿科学]