临床表现为肾病综合征的特发性膜性肾病患者临床病理特点以及预后不良因素分析  

Clinicopathological characteristics and poor prognostic factors of idiopathic membranous nephropathy patients with clinical manifestations of nephrotic syndrome

作　　者：陈宇[1] 陈若如[1] 黄蔚霞[1] CHEN Yu;CHEN Ruo-ru;HUANG Wei-xia(Department of Nephrology,Wenzhou Traditional Chinese Medicine Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江省温州市中医院肾内科,温州325000

出　　处：《浙江中西医结合杂志》2022年第11期986-990,996,共6页Zhejiang Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的通过比较有无临床表现为肾病综合征的特发性膜性肾病(IMN)患者肾穿刺基线临床病理资料,探讨预后相关的因素。方法回顾性分析2006年9月至2019年11月浙江省温州市中医院经肾活检确诊为IMN并有完整随访资料的患者共345例,根据患者有无临床表现为肾病综合征分为有肾病综合征组202例和无肾病综合征组143例,比较两组间肾穿刺时的基线临床、病理资料,并对预后进行分析。主要结局:血肌酐(Scr)翻倍或全因死亡或进展至终末期肾病(ESRD);次要结局:完全缓解和部分缓解。结果有肾病综合征组男性居多,更多合并水肿(91.1%)和血尿(45.0%),收缩压和舒张压偏高,病程更短;白蛋白、血IgG更低、尿蛋白更多,纤维蛋白原、Scr、低密度酯蛋白胆固醇(LDL-CH)更高,病理程度更重,系膜基质增生、间质炎性细胞浸润、肾小管萎缩、肾脏C3沉积均更严重,与无肾病综合征组比较差异有统计学意义(P<0.05)。Cox多因素回归分析发现,年龄、血补体C3、血尿素氮(BUN)、Scr、血尿酸(UA)、三酰甘油(TG)、eGFR是肾脏预后不良的危险因素,而高血压、尿蛋白、血沉、肾脏IgA沉积等是临床缓解的预后因素。采用Kaplan-Meier法绘制肾脏生存曲线,比较有无肾病综合征两组间主要终点事件和次要终点事件的差异。发现有肾病综合征组较无肾脏综合征组累积肾脏存活率更低,更容易发生不良结局(P=0.0018),而次要终点事件的发生差异无统计学意义(P=0.9104)。结论肾穿刺基线时临床表现为肾病综合征的IMN患者临床病情和病理程度均较无肾病综合征组更重,年龄、血BUN、Scr、UA、eGFR、TG是肾脏不良结局的独立危险因素,临床表现为肾病综合征的IMN患者预后更差,更容易进展至ESRD。Objective To assess the clinicopathological characteristics and poor prognostic factors of idiopathic membranous nephropathy(IMN)patients with or witout clinical manifestations of nephrotic syndrome.Methods A total of 345 IMN patients confirmed by renal biopsy with completed follow-up data between September 2006 and November 2019 in Wenzhou Traditional Chinese Medicine Hospital in Zhejiang Province were retrospectively recruited and analyzed according to presence or absence of nephrotic syndrome.Patients were divided into nephrotic syndrome(n=202)and no nephrotic syndrome(n=143)groups and the clinical baseline characteristics and prognosis between two groups were compared,including clinicopathological characteristics and serum level of creatinine,allcause death or progression to end-stage renal disease(ESRD),complete remission(CR),and partial remission(PR).Results Nephrotic syndrome group of patients had more male,edema(91.1%),hematuria(45.0%),higher systolic and diastolic blood pressures,shorter course of disease,lower serum albumin and IgG,but high level of urinary protein,serum fibrinogen,creatinine,and LDL as well as serious renal pathology(all P<0.05).Moreover,there were more severities in the mesangial matrix hyperplasia,interstitial inflammatory cell infiltration,renal tubule atrophy,and renal C3 deposition in Nephrotic syndrome group of patients than those without nephrotic syndrome(P<0.05).The Cox multivariate regression analytic data showed that age and serum levels of complement C3,urea nitrogen,creatinine,uric acid,triglyceride,and eGFR were risk factors for poor renal prognosis,while hypertension,urinary protein,ESR and renal IgA deposition were prognostic factors for clinical remission.The Kaplan-Meier curves showed that the nephrotic syndrome patients had a poorer accumulative renal survival rate and were more prone to adverse outcomes than patients without nephrotic syndrome(P=0.0018),although there was no statistically significant difference in disease remissions(CR or PR;P=0.9104).Conclusion IMN

关 键 词：特发性膜性肾病 肾病综合征 临床 病理 预后 

分 类 号：R692[医药卫生—泌尿科学]