成人特发性膜性肾病临床病理特征及预后研究

摘要

目的：总结成人特发性膜性肾病临床病理特征及预后相关因素。方法：回顾性分析82例IMN患者临床、病理及随访资料，总结其临床病理特点，并以eGFR＜30mL／min为随访终点，将患者分为肾功能进展组及肾功能稳定组，比较两组患者临床资料。结果：82例患者中有肾病综合征者56例（68．29％），合并高血压31例（37．8％），病理分期I期25例（30．48％），Ⅱ期50例（60．98％），随访过程中有12例患者eGFR＜30mL／min，两组患者比较在平均动脉压、临床表现为肾病综合征比例、eGFR、胆固醇、24h尿蛋白定量、合并肾小管间质损害比例方面差异有统计学意义（ P＜0．05）。结论：成人特发性膜性肾病患者临床以肾病综合征多见，病理分期以Ⅰ期、Ⅱ期为主，高血压、临床出现肾病综合征、大量蛋白尿、肾功能损伤、高胆固醇血症及合并肾小管间质损害与IMN患者肾功能恶化进展有关。%Objective:To summarize the clinical pathological features and prognostic factors of adult idi-opathic membranous nephropathy (IMN).Method:Clinical, pathological and follow-up data of 82 patients with IMN was analyzed retrospectively , the clinical and pathological features were summarized , and end of follow-up was eGFR <30 mL/min, The patients were divided into groups of renal function steady and renal function progress, clinical data was compared.Result: In 82 patients,there were 56 cases (68.29%)with nephrotic syndrome , 31 cases ( 37.8%) with hypertension , pathological stage I was 25 cases ( 30.48%) ,stage Ⅱwas 50 cases (60.98%), in the follow-up process, there were 12 cases of patients with eGFR <30 mL /min, comparing two groups of patients ,there's statistically significant in mean arterial pressure , the proportion of nephrotic syndrome clinical manifestations , eGFR, cholesterol, 24h urine protein, interstitial renal tubular damage (P <0.05).Conclusion:Nephrotic syndrome is the most common clinical manifesta-tions in patients with IMN , the most common pathological stage is I and II , and hypertension , nephrotic syn-drome, proteinuria, renal damage, hypercholesterolemia and interstitial renal tubular damage is associated with the progress of renal function in patients with IMN .