118例特发性膜性肾病临床及病理特点分析  

Clinical and pathological features of idiopathic membranous nephropathy: a report of 118 cases

作　　者：赵黎[1] 金娟[1] 龚建光[1] 何强[1] 

机构地区：[1]浙江省人民医院肾脏病科,浙江杭州310014

出　　处：《中华全科医学》2018年第3期360-363,共4页Chinese Journal of General Practice

基　　金：浙江省自然科学基金(LY16H050005);浙江省医药卫生一般项目(2015KYA025);浙江省中医药科研项目(2015ZA011;2016ZA023)

摘　　要：目的总结特发性膜性肾病(idiopathic membranous nephtopathy,IMN)的临床及病理特点。方法回顾性分析浙江省人民医院2013年1月—2016年10月经肾活检确诊的118例IMN患者的完整临床及病理资料。结果118例IMN患者中男性69例(58.5%),女性49例(41.5%);年龄(51.7±12.3)岁,中老年患者占74.6%;蛋白尿0.07~27.60 g/24 h,其中≥3.50 g/24 h者69例(58.5%);肾病综合征76例(64.4%);血尿102例(86.4%);肾小球滤过率(e GFR)≥60 ml/(min·1.73 m^2)者102例(86.4%),<60 ml/(min·1.73 m^2)者16例(13.6%)。与女性比较,男性患者血清中肌酐、尿素氮及尿酸水平均较高,差异均有统计学意义。随年龄增长,肾功能下降更明显,肾小管间质损伤程度加重,肾小球球性硬化患者更多,小动脉病变更明显;肾小球病理分期以Ⅰ、Ⅱ期为主,占97.5%。结论男性、年龄大、尿酸水平高、尿蛋白量多者,肾功能减退多见,肾小管间质病变重,小动脉病变明显,故宜尽早就诊并行穿刺活检。Objective To summarize the clinic-pathological features of idiopathic membranous nephropathy（ IMN）.Methods The clinical and pathological data of 118 cases of IMN confirmed by biopsy in Zhejiang Provincial People＇s Hospital from January,2013 to October,2016 were analyzed retrospectively. Results Of the 118 IMN patients,there were 69 males and 49 females,with mean age of 51. 7 ± 12. 3（ 74. 6% of them were 44 years or more）. The level of protein in urine was 0. 07-27. 60 g/24 h,and 3. 5 g/24 h or more in 58. 5% of them. 76 cases（ 64. 4%） were with nephrotic syndrome,102 cases（ 86. 4%） with hematuria. 102 cases（ 86. 4%） were with e GFR of 60 ml/（ min·1. 73 m^2）or more,and 16 cases with e GFR less than 60 ml/（ min·1. 73 m^2）. When compared with female patients,the male patients were with higher levels of serum creatinine level,blood urine nitrogen and uric acid level,the difference was statistically significant（ P〈 0. 05）. Age and urine protein quantification had positive correlation with the level of serum creatinine,urate,e GFR,tubulointerstitial lesions,glomerulus sclerosis and small artery injury. Pathological stage Ⅰ and Ⅱof IMN were the dominant pathologic pattern,which accounted for 97. 5% cases. Conclusion The aged male IMN patients are usually with high uric acid and urine protein levels,renal hypofunction,tubulointerstitial lesions and small artery injury,and the early renal biopsy and diagnosis should be recommended to IMN patients.

关 键 词：特发性膜性肾病 肾病综合征 临床表现 病理特点 

分 类 号：R692[医药卫生—泌尿科学]