【摘要】 目的:探讨成人特发性膜性肾病(IMN)的临床与病理特点,分析年龄因素和有无伴局灶节段性肾小球硬化(FSGS)对IMN临床病理的影响。方法:回顾性分析温州地区2006年9月～2011年4月经临床及肾活检诊断为IMN且具有完整临床病理资料的患者91例,分别按年龄(16岁～30岁,31岁～60岁和61岁～80岁)和有无FSGS(FSGS+和FSGS-)分层,分析其临床、病理特征的关系。结果:IMN好发于中年男性,31岁～60岁居多(62.6%),以浮肿(80.2%)、肾病综合征(52.7%)、高血压(47.3%)、镜下血尿(63.7%)为主要临床表现,肾衰竭(3.3%)较少,病理分期以Ⅰ、Ⅱ期为主。61岁～80岁组中肾病综合征以及小管间质和小血管病变重的相对较多,血尿素氮较高,血白蛋白和eGFR较低。FSGS+和FSGS-两组间临床表现、实验室指标及病理指标均差异无统计学意义。多因素二元Logistic回归分析显示血肌酐、病理分期是发生FSGS的主要危险因素。结论:年龄大的IMN患者临床和病理表现较重的比例相对增加,以血尿素氮、肾小球滤过率、小管间质和小血管病变方面较突出。血肌酐和病理分期是发生局灶节段性肾小球硬化的独立危险因素。更多还原

【Abstract】 Objective:To investigate the clinical and pathological features of idiopathic membranous nephropathy(IMN) in adults.To analyze the factors of age and focal segmental glomerulosclerosis (FSGS)’s effect on clinic and pathology.Methods:91 patients with clinical data were retrospectivly analysed whose diagnosis were IMN by clinical and renal biopsy between Sep.2006 to Apr.2011 in the Wenzhou area,the relationship between clinic and pathology were analyzed onthe basis of age(16～30 year,31～60 year and 61～80 year) and FSGS (FSGS+ and FSGS-) respectively.Results:Middle-aged male patients were inclined to IMN,especially from 31～60 year(62.6%).Edema(80.2%),nephrotic syndrome(52.7%),hypertension(47.3%) and microscopic hematuria(63.7%) were major clinical manifestation,though renal insufficiency was rare.Most cases were classified as stageⅠorⅡmembranous lesions in pathology.The symptoms of nephrotic syndrome and the severe damage of tubulo-interstitium and blood vessel were more common in 61-80 year group while BUN was higher,blood albumin and eGFR were lower.There was no significant statistic difference between FSGS+ and FSGS- among clinical manifestation,experimental index and pathological features.Serum creatinine and pathological stages were major risk factors in FSGS by Binary Logistic regression analysis.Conclusion:The elder the patients,the more common the severe damage of clinic and pathology in IMN patients,especially in BUN,eGFR,tubulo-interstitium and blood vessel.Serum creatinine and pathological stages were independent risk factors in FSGS.更多还原