60岁及以上特发性膜性肾病患者的临床表现和病理特点  

Clinicopathology characteristics of idiopathic membranous nephropathy in elderly patients

作　　者：徐茜茜[1] 卓莉[1] 邹古明[1] 高红梅[1] 李文歌[1] Xu Qianqian;Zhuo Li;Zou Guming;Gao Hongmei;Li Wenge(Department of Nephrology, China-Japan Friendship Hospital ,Beijing 100029, China)

机构地区：[1]中日友好医院肾内科,北京100029

出　　处：《中华全科医师杂志》2018年第6期452-456,共5页Chinese Journal of General Practitioners

摘　　要：目的 探讨老年特发性膜性肾病（IMN）患者的临床表现和病理特点.方法 回顾性分析2006年1月至2016年12月在中日友好医院经肾活检证实的400例IMN患者的临床资料.其中≤44岁者153例（青年组）,45 ～ 59岁者167例（中年组））、≥60岁者80例（老年组）,对比分析老年和青、中年组患者之间的临床病理特点.结果 老年组平均年龄（64.9±4.3）岁,男女比例为1.42：1.老年组估算的肾小球滤过率（eGFR） （91.1 ±25.9） ml·min-1·1.73 m-2,明显低于青年组的（119.8 ±37.0） ml·min-1·1.73 m-2及中年组的（102.5±33.2） ml· min-1·1.73 m-2（F=21.74,P=0.000）;老年组高血压患病率（40.0％,32/80）明显高于青年组（19.6％,30/153）和中年组（22.2％,37/167）（x2=12.76,P=0.003）.病理类型方面,老年组IMN合并缺血性肾损伤或间质小管损伤的发生率（15.0％,12/80）明显高于青年组（5.8％,9/153）（x2=5.31,P=0.021）.结论 老年IMN患者高血压的患病率及合并缺血性肾损伤或间质小管损伤的发生率均高于青年、中年组,提示老年IMN患者的预后较差,应重视疾病的早期诊断和治疗.Objective To investigate the clinicopathological characteristics of idiopathic membranous nephropathy （IMN） in elderly patients.Methods Clinicopatholigical data of 400 patients with IMN identified by renal biopsy from January 2006 to December 2016 were analyzed retrospectively.The patients were divided into three groups：the young （≤44 years old）,the middle-aged （45-59 years old） and the elderly （≥60 years old）,and the clinicopathological characteristics were compared among three groups.Results The average age of the elderly group was （64.9 ± 4.3） years,the elderly group had worse renal function than the young group （F =784.60,P =0.000） and the middle-aged group [estimated glomerular filtration rate （eGFR） were （91.1 ± 25.9） 、（119.8 ± 37.0） and （102.5 ± 33.2） ml · min-1 · 1.73 m-2,F =21.74,P =0.000].The incidence of hypertension was higher in the elderly group than the other two groups [40.0％ （32/80） vs.19.6％ （30/153） and 22.2％ （37/167）,x2 =12.76,P =0.003].The incidence of MN with ischemic nephropathy and tubulointerstitial lesion in the elderly group was higher than in the young group[15.0％ （12/80） vs.5.8％ （9/153）,x2 =5.31,P =0.021].Conclusion The elderly patients with IMN are likely to be complicated with hypertension,ischemic nephropathy and tubulointerstitial lesions indicating poorer prognosis,so more attention should be paid to the early diagnosis and treatment of these comorbidities.

关 键 词：肾病 肾小球肾炎 膜性 病理状态 体征和症状 年龄组 

分 类 号：R692[医药卫生—泌尿科学]