单中心成人特发性膜性肾病的临床病理特点和预后分析  

Clinicopathological Characteristics and Prognosis of Adult Idiopathic Membranous Nephropathy in a Single Centre

作　　者：陈巧玲[1] 林婉君 廖永根 叶秋萍 刘丽芳 魏立新[1] CHEN Qiaoling;LIN Wanjun;LIAO Yonggen;YE Qiuping;LIU Lifang;WEI Lixin(Fujian Medical University Union Hospital,Fuzhou 350001,China;不详)

机构地区：[1]福建医科大学附属协和医院,福建福州350001

出　　处：《中国医学创新》2022年第24期59-65,共7页Medical Innovation of China

基　　金：福建省自然科学基金项目(2018J05136)。

摘　　要：目的:分析成人特发性膜性肾病(IMN)患者临床病理特点及预后影响因素。方法:回顾性分析2015年1月1日-2019年12月31日在福建医科大学附属协和医院肾内科首次行超声引导下肾穿刺活检术并确诊为IMN的135例成人患者的临床资料。定义终点事件为估算的肾小球滤过率(eGFR)水平下降30%且<60 mL/(min·1.73 m^(2)),分析患者肾脏预后的影响因素。结果:本研究共纳入135例成人IMN患者,男女比例为1.29∶1,发病年龄为53.00(45.00,60.00)岁,35例(25.93%)患者年龄≥60岁,106例(78.52%)患者表现为肾病综合征,84.44%患者抗磷脂酶A_(2)受体(PLA_(2)R)抗体阳性。病理类型以Ⅱ期为主,10^(9)例(80.74%)。随访时间31.70(17.87,45.73)个月。单因素Cox分析显示年龄、合并高血压、合并糖尿病、基线血肌酐升高、基线eGFR、并发急性肾损伤、发生缓解是肾脏预后的独立影响因素(P<0.05)。多因素Cox分析显示基线eGFR[HR=0.968,95%CI(0.939,0.998),P=0.039]和发生缓解[HR=0.159,95%CI(0.044,0.569),P=0.005]是肾脏预后的独立影响因素。结论:基线eGFR和发生缓解是成人IMN肾脏预后的独立影响因素。针对成人IMN患者应制订个体化治疗方案,争取达到缓解,对于基线eGFR下降的患者,更应密切监测,保护肾功能,改善预后。Objective:To analyze the clinicopathological characteristics and prognostic factors of adult idiopathic membranous nephropathy(IMN).Method:The clinical data of 135 adult patients diagnosed with IMN who underwent ultrason-guided renal biopsy for the first time in the Department of Nephrology,Fujian Medical University Union Hospital from January 1,2015 to December 31,2019 were retrospective analyzed.The endpoint event was defined as a 30%decrease in the estimated glomerular filtration rate(eGFR)level and<60 mL/(min·1.73 m^(2)),the influencing factors of renal prognosis were analyzed.Result:A total of 135 adult IMN patients were included in this study,the male to female ratio was 1.29∶1,onset age was 53.00(45.00,60.00)years,35(25.93%)patients were≥60 years old,106(78.52%)patients presented with nephrotic syndrome,and 84.44%patients had positive blood PLA_(2)R antibody.The main pathological type was stageⅡ,10^(9)cases(80.74%).Follow-up time was 31.70(17.87,45.73)months.Univariate Cox analysis showed that age,hypertension,diabetes,baseline serum creatinine,baseline eGFR,acute kidney injury and remission were independent influencing factors for renal prognosis(P<0.05).Multivariate Cox analysis indicated that baseline eGFR[HR=0.968,95%CI(0.939,0.998),P=0.039]and remission[HR=0.159,95%CI(0.044,0.569),P=0.005]were independent factors influencing renal prognosis.Conclusion:The baseline eGFR and remission are independent factors affecting renal prognosis of adult IMN.For adult patients with IMN,an individualized treatment plan should be developed to achieve remission,for patients with a decreased baseline eGFR,close monitoring should be performed to protect renal function and improve prognosis.

关 键 词：特发性膜性肾病 临床病理特点 预后 

分 类 号：R692[医药卫生—泌尿科学]