165例特发性膜性肾病临床及病理特征与肾功能的相关性分析  

Correlation analysis of clinical and pathological features and renal function of idiopathic mem-branous nephropathy in 165 cases

作　　者：韦翠美 何永成[1] 李彤[1] 刘洪萍[1] 胡豪飞 程媛 宋海英[1] 齐东丽[1] 陈嘉[1] 邓志勇 Wei Cuimei;He Yongcheng;Li Tong;Liu Hongping;Hu Haofei;Cheng Yuan;Song Haiying;Qi Dongli;Chen Jia;Deng Zhiyong(Department of Nephrology,the Second People's Hospital of Shenzhen City,Shenzhen 518035,China)

机构地区：[1]深圳市第二人民医院肾内科,518035

出　　处：《国际泌尿系统杂志》2019年第4期585-589,共5页International Journal of Urology and Nephrology

基　　金：深圳市科创委基础研究项目(JCYJ20130329104904512);深圳市科创委技术开发项目(CXZZ20140421155346007);深圳市科创委技术开发项目(CXZZ20150601140615135);深圳市卫计委学科建设能力提升项目(SZXJ2017031).

摘　　要：目的研究特发性膜性肾病(IMN)患者肾功能水平与临床及病理特征之间的相关性.方法对2010年1月至2016年12月于深圳大学附属第一医院确诊的165例IMN患者的临床及病理资料进行回顾性分析;按照基线肾功能水平eGFR(估算肾小球滤过率)分为CKD1期组、CKD2期组、CKD3+4+5期组,比较患者人口学、临床生化指标及病理指标等的差异.采用相关性方程分析肾功能与年龄、24h尿蛋白量、血压、临床生化指标及病理指标的相关性.采用二元logistic回归方程分析影响肾功能下降的危险因素.结果①患者年龄14~84(45.33±15.19)岁,临床表现为肾病综合征82例(49.6%),伴高血压76例(46.1%),合并水肿129例(78.1%);②与CKD1期的患者相比,CKD2期以上的患者临床及病理具有男性比例高、高龄、高血压及肾病综合征发生率高的特点,且CKD分期越高(即eGFR水平越低)的患者,肾小球节段硬化、肾间质炎症细胞浸润及肾小动脉壁增厚的比例越高;③相关性分析结果提示,肾功能与年龄、高血压、24h尿蛋白、血清尿酸水平、肾间质炎症细胞浸润、肾小管萎缩、肾小动脉壁增厚呈负相关(P<0.05);④logistic多因素回归分析显示性别、24h尿蛋白定量、高尿酸血症、肾间质炎症细胞浸润为IMN患者肾功能损害的独立危险因素.结论IMN患者初诊时年龄、是否合并肾病综合征及高血压是eGFR下降的相关因素;男性、大量蛋白尿、高尿酸血症、肾间质炎症细胞浸润是影响IMN患者肾功能重要的预测因子.Objective To explore the relationship between renal function and clinical and pathological features of 165 patients with idiopathic membranous nephropathy ( IMN). Methods One hundred and sixty five patients with IMN from January 2010 to December 2016 in the hospital were se-lected in this study. According to the baseline renal function level eGFR ( estimated glomerular filtra-tion), all patients were divided into CKD1 group, CKD2 group, and CKD3+4+5 group. The demo-graphics characteristic, clinical biochemical examination and pathological indicators were compared. Pearon or spearman correlation was used to analyze the relationship of renal function. Risk factors for eGFR decline were analyzed by binary logistic regression. Results ①Among 165 patients with IMN,the age ranged from (45.33 ±15.19)years (range 14 to 84 years). The clinical manifestations were nephrotic syndrome (82 cases, 49. 6%), 76 with hypertension (46. 1%), 129 with edema (78. 1%).②Compared with patients with CKD stage 1, the clinical and pathological characteristics of pa-tients above CKD stage 2 were characterized by higher proportion of males, older age, higher incidence of hypertension and nephrotic syndrome.③Correlation analysis showed that renal function was negative-ly correlated with age, hypertension, 24-hour urinary protein, serum uric acid levels, renal interstitial inflammatory cell infiltration, renal tubular atrophy, and renal arterial wall thickening (P<0. 05).④Regression analysis showed that gender, 24-hour urinary protein, hyperuricemia, renal interstitial in-flammatory cell infiltration were independent risk factors for renal impairment in patients with IMN. Conclusions IMN patients with initial diagnosis of age, gender, nephrotic syndrome and hypertension are associated with decreased eGFR. However, male, hyperalbuminuria, hyperuricemia, and renal in-terstitial inflammatory cell infiltration are important predictors of renal function in patients with IMN.

关 键 词：肾小球肾炎 膜性 肾功能试验 病理状态 体征和症状 

分 类 号：R692[医药卫生—泌尿科学]