膜性肾病临床及病理分析  

Clinical and pathological analysis of membranous nephropathy

作　　者：李亚林[1] LI Yalin(Department of Nephrology,the First Hospital of Handan City,Handan 056002,China)

机构地区：[1]河北省邯郸市第一医院肾内科

出　　处：《中国医药科学》2019年第21期20-23,共4页China Medicine And Pharmacy

摘　　要：目的分析膜性肾病临床表现及病理特点。方法采用简单随机法选取我院2014年11月~2018年11月174例膜性肾病患者进行回顾性研究,收集患者临床资料,分析其临床表现及病理特点。结果临床表现方面,肾炎综合征9例,占5.17%;肾病综合征165例,占94.83%。合并高血压60例,合并高血糖或糖尿病9例,合并血尿101例,合并肾功能不全25例。Ⅰ期膜性肾病128例,占73.56%;Ⅱ期膜性肾病51例,占29.31%。免疫荧光法检查显示,所有患者均存在Ig G沉着,C3沉着163例,Ig M沉着45例。Ⅰ期和Ⅱ期患者相比,年龄、24h尿蛋白定量、合并高血压、合并肾病综合征、肾小球球性硬化、肾小管间质损伤差异均有统计学意义(P<0.05)。Ⅰ期Ig G、C3、FRA、C1q阳性率和Ⅱ期对比差异无统计学意义(P>0.05);Ⅰ期Ig A、Ig M阳性率高于Ⅱ期,P<0.05。结论膜性肾病多发生于中老年患者,且男性发病率略高于女性,多数患者病理分期为Ⅰ期和Ⅱ期,且年龄、24h尿蛋白定量、合并高血压、合并肾病综合征等因素与病理分期密切相关。Objective To analyze the clinical manifestations and pathological features of membranous nephropathy. Methods 174 patients with membranous nephropathy in our hospital from November 2014 to November 2018 were randomly selected for retrospective study.Clinical data of patients were collected to analyze their clinical manifestations and pathological characteristics. Results In terms of clinical manifestations,nephritis syndrome was found in 9 cases,accounting for 5.17%.Nephrotic syndrome was found in 165 cases,accounting for 94.83%.There were 60 cases with hypertension,9 cases with hyperglycemia or diabetes,101 cases with hematuria and 25 cases with renal insufficiency.There were 128 cases of stage Ⅰ membranous nephropathy,accounting for 73.56% and 51 cases of stage Ⅱ membranous nephropathy,accounting for 29.31%.Immunofluorescence examination showed that all patients had IgG deposition,including 163 cases of C3 deposition and 45 cases of IgM deposition.Compared with patients with stage Ⅰ,age,24 h urine protein quantitation,combination with hypertension,combination with nephrotic syndrome,glomerular sclerosis and tubulointerstitial injury of patients with stage Ⅱ were significantly different(P<0.05).There was no significant difference in the positive rate of IgG, C3,FRA and C1 q between phase Ⅰ and phase Ⅱ(P>0.05).The positive rates of IgA and IgM in stage Ⅰ were higher than those in stage Ⅱ,P<0.05. Conclusion Membranous nephropathy occurs mostly in middle-aged and elderly patients and the incidence of men is slightly higher than that of females.Most patients have pathological stages Ⅰ and Ⅱ.And age,24 h urine protein quantification, combination with hypertension and combination with nephrotic syndrome are closely related to pathological staging.

关 键 词：膜性肾病 肾功能 慢性肾功能衰竭 病理分型 免疫荧光法 肾小球球性硬化 免疫治疗 肾炎综合征 肾病综合征 

分 类 号：R692[医药卫生—泌尿科学]