摘要
目的:探讨黑龙江地区特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床病理特征及与肾小球滤过率(estimated glomerular filtration rate,eGFR)下降相关危险因素,为IMN的治疗及预后评估提供依据。方法:回顾性分析2014年1月至2016年12月期间确诊为IMN的309例患者临床病理资料。结果:309例IMN中,288例(93.20%)为肾病综合征,21例(6.80%)为慢性肾炎;269例患者eGFR≥90 mL/(min·1.73 m^2),40例患者eGFR<90 mL/(min·1.73 m^2);40～60岁为IMN的高发年龄段,各年龄段均为男性发病率更高;236例(76.6%)患者病理分期为Ⅱ期IMN,免疫复合物主要沉积部位为上皮下及基底膜。中、老年组收缩压水平更高,eGFR和血红蛋白水平偏低,在肾间质病变上程度更严重。eGFR<90 mL/(min·1.73 m^2)的患者血压水平和尿总蛋白量偏高,血清白蛋白水平更低,肾间质病理改变更严重。多因素分析表明高胆固醇、血压水平、肾间质炎性细胞浸润及肾小球硬化是与eGFR降低相关的独立危险因素。结论:控制高胆固醇血症和高血压,控制肾间质炎性细胞浸润及延缓肾小球硬化有利于改善IMN患者eGFR下降水平以及预后。
Objective: To investigate the clinicopathological features of idiopathic membranous nephropathy(IMN) and risk factors for decrease of estimated glomerular filtration rate(eGFR), and to provide evidence for the treatment and evaluation of the prognosis in patients with IMN. Methods: The clinical and pathological data of 309 patients diagnosed as IMN from January 2014 to December 2016 were retrospectively analyzed. Results: Of the 309 IMN patients, 288(93.20%) presented nephrotic syndrome, 21(6.80%) presented chronic nephritis. A total of 269 patients had eGFR ≥90 mL/(min·1.73 m^2), and 40 patients had eGFR <90 mL/(min·1.73 m^2). The high-incidence age of IMN is 40–60 years old, males have higher incidence in all ages. A total of 236(76.6%) patients demonstrated stage Ⅱ IMN, and the main deposition sites of immune complexes are subepithelial and basement membrane. In the middle and old age groups, the incidence of systolic blood pressure were higher, eGFR and hemoglobin levels were lower, and the degree of renal interstitial lesions was more serious. In patients with eGFR <90 mL/(min·1.73 m^2)the blood pressure level and total urinary protein level were higher, serum albumin levels were lower, and renal interstitial pathological changes were more serious. Multivariate analysis showed that high cholesterol, systolic blood pressure, renal interstitial inflammatory cell infiltration, and glomerular sclerosis were independent risk factors associated with decreased eGFR. Conclusion: Control of hypercholesterolemia and hypertension, control of renal interstitial inflammatory cell infiltration and delay of glomerular sclerosis are beneficial to improve the level of eGFR and prognosis in patients with IMN.
作者
李怡然
解汝娟
隋满姝
那士平
穆素红
李丽
贾西贝
刘睿婵
包宇实
LI Yiran;XIE Rujuan;SUI Manshu;NA Shiping;MU Suhong;LI Li;JIA Xibei;LIU Ruichan;BAO Yushi(Department of Nephrology,First Affiliated Hospital, Harbin Medical University,Harbin 150001,China)
出处
《临床与病理杂志》
2018年第11期2409-2415,共7页
Journal of Clinical and Pathological Research
基金
黑龙江省自然科学基金(H201337)~~
关键词
特发性膜性肾病
病理
肾小球滤过率
危险因素
idiopathic membranous nephropathy
pathology
estimated glomerular filtration rate
risk factors
