不同年龄段特发性膜性肾病患者的临床病理特征及预后分析  

Clinicopathological features and prognosis in patients with idiopathic membranous nephropathy of different ages

作　　者：陈宇[1] 陈若如[1] 黄蔚霞[1] CHEN Yu;CHEN Ruoru;HUANG Weixia(Department of Nephrology,Wenzhou Traditional Chinese Medicine Hospital,Wenzhou 325000,China)

机构地区：[1]温州市中医院肾内科,325000

出　　处：《浙江医学》2022年第7期719-723,共5页Zhejiang Medical Journal

基　　金：浙江省自然科学基金项目(LY16H150007)。

摘　　要：目的比较不同年龄段特发性膜性肾病(IMN)患者的临床病理特征,并分析其预后情况。方法回顾性选取2006年9月至2019年11月在温州市中医院经肾活检诊断为IMN并有完整随访资料的患者345例。其中年龄<35岁的66例患者为青年组,35~60岁的175例患者为中年组,>60岁的104例患者为老年组。分析并比较3组患者的临床资料、肾脏病理特征及预后情况,包括发生主要终点事件和次要终点事件。主要终点事件:血肌酐翻倍或全因死亡或进展至终末期肾病(ESRD)。次要终点事件:完全缓解(CR)和部分缓解(PR)。结果青年组和老年组患者中男性比例高于中年组(均P<0.05)。老年组患者水肿、高血压比例>中年组>青年组(均P<0.05)。青年组患者血总蛋白、血白蛋白、血IgG、血补体3等水平异常最严重,其次为老年组,中年组最佳(均P<0.05)。与其他两组比较。3组患者血尿素氮、血肌酐、血尿酸、TC、LDL、eGFR等水平异常及血肌酐翻倍或进展至ESRD均最严重,CR或PR比例最低(均P<0.05)。3组患者球性硬化、间质炎性细胞浸润、间质纤维化、肾小管萎缩、小动脉壁增厚、细动脉透明变性、小动脉病变等情况比较差异均有统计学意义(均P<0.05)。老年组患者累积肾脏存活率最低,最容易发生ESRD,其次为青年组,而中年组预后最佳(P<0.05)。3组患者次要终点事件生存曲线比较差异无统计意义(P>0.05)。结论老年IMN患者更多合并高血压等慢性疾病,而青年IMN患者起病时病情往往更重。随着年龄增长,患者的基础肾功能、小管间质病变和小动脉硬化等病变均逐渐加重。老年IMN患者预后最差,青年患者次之,而中年患者预后相对较好。Objective To compare the clinicopathological features and prognosis in patients with idiopathic membranous nephropathy(IMN)of different age groups.Methods The clinical and follow-up data of 345 patients with IMN diagnosed by renal biopsy in Wenzhou Traditional Chinese Medicine Hospital from September 2006 to November 2019 were retrospectively analyzed.There were 66 patients aged<35 years(youth group),175 patients aged 35-60 years(middle-aged group),and 104 patients aged>60 years(elderly group).The clinical data and renal pathological features in 3 groups were compared.The prognosis,including primary end point events(doubling of serum creatinine or all-cause death or progression to end-stage renal disease,ESRD)and secondary end point events(complete remission,CR and partial remission,PR).Results The proportion of males in the youth group and the elderly group was higher than that in the middle-aged group(all P<0.05).Proportion of edema and hypertension in the elderly group was higher than that in the middle-aged group,and the later was higher than that of the youth group(all P<0.05).The abnormal levels of serum total protein,serum albumin,serum IgG and C3 were the most severe in the youth group,followed by the elderly group and the middle-aged group(all P<0.05).Compared with other two groups,the abnormality of serum urea nitrogen,serum creatinine,serum uric acid,TC,LDL,eGFR and the doubling of serum creatinine or progression to ESRD were the most severe in the elderly group,and the proportion of CR or PR was the lowest(all P<0.05).There were significant differences in bulbous sclerosis,interstitial inflammatory cell infiltration,interstitial fibrosis,renal tubule at-rophy,arteriole wall thickening,arteriole hyaline degeneration,arteriole lesions among the three groups(all P<0.05).Patients in the elderly group had the lowest cumulative renal survival rate and were more prone to poor prognosis,followed by the youth group;and the middle-aged group had the best prognosis(P<0.05).There was no significant difference in

关 键 词：特发性膜性肾病 年龄 临床 病理 预后 

分 类 号：R692[医药卫生—泌尿科学]