69例膜性肾病临床特点与病理资料分析

Clinical and pathology features of membranous nephropathy: An analysis of 69 cases

  • 摘要: 目的 探讨成人膜性肾病(membranous nephropathy,MN)的病理及临床特点。 方法 回顾性分析2010年7月-2013年7月于辽宁医学院附属第一医院肾内科住院并行肾穿刺活检回报为膜性肾病的69例患者的临床资料。对患者年龄、性别、血清白蛋白、尿蛋白定量、高血压、尿潜血、甘油三酯等临床指标与病理类型进行分析。 结果 69例患者的年龄为(46.2±14.2)岁,男性45例,女性24例,男女比例1.875∶1。原发性膜性肾病55例(79.7%);继发性膜性肾病14例(20.3%),其中乙肝病毒相关性膜性肾病7例(50%),Ⅴ型狼疮性肾炎1例(7.1%)。临床表现为肾病综合征54例(78.26%),肾炎综合征15例(21.74%),伴有镜下血尿21例(30.43%),伴有高血压17例(24.64%),伴有肾功能不全4例(5.80%)。病理表现:Ⅰ期膜性肾病25例36.2%,Ⅱ期膜性肾病30例(43.5%),Ⅲ及Ⅳ期未收集到。免疫荧光下可见免疫复合物沉着主要为免疫球蛋白G(IgG)和补体C3,分别为69例(100%)和65例(94.2%);21例(30.4%)可见免疫球蛋白A(IgA)沉积,18例(26.1%)可见免疫球蛋白M(IgM)沉着;乙肝病毒相关膜性肾病可见乙型肝炎表面抗原和(或)乙型肝炎核心抗原表达。男性、老龄、高血压、24 h尿蛋白定量高的患者病理分期高(P< 0.05)。 结论 膜性肾病好发于中老年男性,病理分期以Ⅰ期和Ⅱ期为主,继发性膜性肾病(secondary membranous nephropathy,SMN)以乙肝相关性膜性肾病为主,特发性膜性肾病(idiopathic membranous nephropathy,IMN)及SMN临床均表现多为肾病综合征,男性、老年、高血压、24h尿蛋白定量多者病理分期高。

     

    Abstract: Objective To investigate the clinical and pathological features of membranous nephropathy (MN) in adults. Methods Clinical data about 69 patients who were diagnosed as membranous nephropathy admitted to The First Affiliated Hospital of Liaoning Medical university from July 2010 to July 2013 were retrospectively analyzed, including their age, gender, serum albumin, proteinuria, hypertension, urinary occult blood, clinical performance, pathological manifestations and laboratory test results. Results The mean age of 69 patients was 46.2±14.2 years old with a male to female ratio of 1.875∶1 (45 males and 24 females). Idiopathic membranous nephropathy (IMN) accounted for 79.7% (55 cases) of the total renal patients biopsied, and secondary membranous nephropathy (SMN) accounted for 20.3% (14 cases), including 7 cases (50.0%) of hepatitis B virus-related membranous nephropathy (HBVMN) and 1 (7.1%) case of Type V lupus nephritis (V-LN). Of the 69 patients, 54 cases (78.26%) performed as nephritic syndrome (NS), 15 cases (21.74%) as glomerulonephritis syndrome, accompanied by microscopic hematuria in 21 cases (30.43%), hypertension in 17 cases (24.64%), renal insufficiency in 4 cases (5.80%). The pathological characteristics showed that phase Ⅰ membranous nephropathy (MN) accounted for 36.2% (25 cases), phase Ⅱ membranous nephropathy accounted for 43.5% (30 cases), and phase Ⅲ as well as phase Ⅳ were not collected. There were excessive deposits of IgG and C3 in kidney tissues in 69 cases (100%) and 65 cases (94.2%), respectively. 21 cases (30.4%) were IgA deposition and 18 cases (26.1%) were IgM deposition. The expression of HBsAg and (or) HBcAg were showed under the hepatitis B virus-associated membranous nephropathy (HBVMN). It suggested that the pathological stages of male aged patients with hypertension and high quantity of 24-hour proteinuria were higher (P< 0.05). Conclusion Membranous nephropathy often occurs in middle and old aged men. The main pathological stages are in phase Ⅰ and phase Ⅱ, and the main cases of SMN is HBVMN. Both IMN and SMN perform as nephrotic syndrome. Elder male patients with hypertension and high quantity of 24-hours proteinuria have higher degree of membranous nephropathy stages.

     

/

返回文章
返回