【摘要】 目的 探讨伴肾小球硬化的特发性膜性肾病(IMN)临床病理特征，分析影响肾小球硬化形成的相关因素。方法 回顾性分析2012年1月至2021年12月在广东省中医院肾内科经肾穿刺活检确诊为IMN的430例患者的临床资料，按照是否合并肾小球硬化分成两组，比较两组患者临床病理特征差异。采用SPSS 25.0软件进行数据分析。根据数据类型，组间比较分别采用t检验、Mann-Whitney U检验，χ~2检验或Fisher确切概率检验。结果 在430例IMN患者中，合并肾小球硬化患者252例(58.6%)。相较于非肾小球硬化组，肾小球硬化组患者病程更长，年龄、合并高血压、糖尿病比例、血清肌酐(SCr)水平更高，预估肾小球滤过率(eGFR)、血红蛋白(Hb)水平更低，差异均有统计学意义(均P<0.05)。病理方面，肾小球硬化组患者肾小管萎缩、肾间质纤维化程度更重，差异均有统计学意义(均P<0.05)。单因素logistic回归分析，结果提示患者的年龄、病程、合并高血压、合并糖尿病、Hb、SCr、eGFR、尿素氮、肾小管萎缩、肾间质纤维化是IMN患者肾小球硬化的相关影响因素(P<0.05);多因素logistic回归分析显示年龄(OR=1.047,95%CI 1.022-1.072;P<0.001)、合并高血压(OR=2.079,95%CI 1.211-3.570;P=0.008)及肾间质纤维化(OR=2.564,95%CI 1.382-4.755;P=0.003)与肾小球硬化形成密切相关。结论 伴肾小球硬化的IMN患者临床病情更重，年龄、合并高血压、肾间质纤维化是肾小球硬化的独立危险因素。临床上对肾活检时出现肾小球硬化的IMN患者更应加强肾功能相关指标的监测，积极治疗并评估IMN病情进展。更多还原

【Abstract】 Objective To investigate the clinicopathological characteristics of idiopathic membranous nephropathy（IMN） complicated with glomerulosclerosis and to analyze the relevant factors for the formation of glomerulosclerosis. Methods A retrospective analysis was performed on 430 IMN patients diagnosed by renal puncture biopsy in Department of Nephrology of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2012 to December 2021. According to complication of glomerulosclerosis or not, they were divided into two groups, and the clinicopathological features were compared between the IMN patients with glomerulosclerosis and those without. SPSS statistics 25.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Mann-Whitney U test, χ² test or Fisher′s exact probability test depending on data type. Results Of the 430 patients with IMN, 252（58.6%） had concomitant glomerulosclerosis. The patients complicated with glomerulosclerosis had significantly longer course of disease, older age, larger proportions of hypertension and diabetes mellitus, and higher serum creatinine（SCr） level, but lower estimated glomerular filtration rate（eGFR） and hemoglobin（Hb） level when compared to those without glomerulosclerosis（P<0.05）. Univariate logistic regression analysis indicated that age, course of disease, hypertension, diabetes melitus, Hb, SCr, eGFR, blood urine nitrogen, renal tubular atrophy and interstitial fibrosis were related influencing factors of glomerulosclerosis in IMN patients（P<0.05）. Multivariate logistic regression analysis suggested that age（OR=1.047, 95%CI 1.022-1.072; P<0.001）, hypertension（OR=2.079, 95%CI 1.211-3.570; P=0.008） and interstitial fibrosis（OR=2.564, 95%CI 1.382-4.755; P=0.003） were associated with glomerulosclerosis formation. Conclusion IMN patients with concomitant glomerulosclerosis are in more serious conditions, and age, hypertension and interstitial fibrosis are independent influencing factors for glomerulosclerosis. In clinical practice, for the IMN patients with identified glomerulosclerosis in renal puncture biopsy, clinicians should strengthen the monitoring of renal function related indicators and actively treat and evaluate the progression of IMN.更多还原