33例青少年特发性膜性肾病的临床病理分析
发布时间：2018-10-12 07:36
【摘要】：目的明确青少年特发性膜性肾病(IMN)的临床病理特点以及肾脏预后。方法回顾性研究2012年6月至2014年12月肾活检病理诊断IMN的青少年患者(定义发病年龄在13~24岁),排除膜性肾病继发病因,收集相关的临床、病理资料。随机选择同期年龄大于24岁的IMN患者33例作为对照组。结果青少年IMN组33人,肾活检时年龄(20±3)岁,男/女比22/11;符合肾病综合征23例,收缩压(127±13)mm Hg(1 mm Hg=0.133 k Pa),舒张压(77±9)mm Hg,24小时尿蛋白中位数5.14(3.39,9.31)g/d,血肌酐62(52,73)μmol/L,血清抗磷脂酶A2受体抗体阳性率54%。与对照组相比,高血压发生率和基线估算肾小球滤过率差异有统计学意义[15.2%比39.3%,χ~2=4.889,P=0.03;125 ml/(min·1.73m~2)比100 ml/(min·1.73m~2),U=137.5,P0.001]。膜性肾病分期:Ⅰ期1例、Ⅱ期21例、Ⅲ期及以上11例;免疫荧光肾小球IgG亚型阳性率分别为:IgG1 46.9%、IgG2 3.1%、IgG3 56.3%、IgG4 87.5%。与对照组相比,青少年组的肾间质纤维化和肾小动脉病变发生率更低(6.1%比66.7%,χ~2=26.19,P0.001;15.2%比66.7%,χ~2=18.11,P0.001)。青少年组出院后失访3例,其余30例初始方案选择:小剂量泼尼松联合环孢素方案20例、泼尼松联合环磷酰胺7例、泼尼松+霉酚酸酯1例、泼尼松单药2例;中位随访时间18(12,24)个月,随访终点24小时尿蛋白中位数0.20(0.10,0.42)g/d,血肌酐69(56.8,81.3)μmol/L,估算肾小球滤过率(117.3±19.2)ml/(min·1.73m~2)。完全缓解17例(56.7%),部分缓解13例(43.4%),完全缓解及部分缓解中位缓解时间分别为3个月和6个月,复发1例。30例随访患者中,完全缓解、部分缓解患者停用免疫抑制剂分别5、4例,其余21例维持治疗:环孢素18例、硫唑嘌呤2例、霉酚酸酯1例。结论青少年IMN肾小球免疫荧光IgG亚型分布及血清抗磷脂酶A2受体抗体阳性率与对照组IMN相似;免疫抑制治疗对青少年IMN有效,小剂量环孢素作为IMN缓解后的维持性治疗有效且不增加肾毒性发生风险。
[Abstract]:Objective to investigate the clinicopathological features and renal prognosis of adolescent idiopathic membranous nephropathy (IMN). Methods from June 2012 to December 2014, the patients with IMN diagnosed by renal biopsy from June 2012 to December 2014 were studied retrospectively. The secondary etiology of membranous nephropathy was excluded and the clinical and pathological data were collected. Thirty-three IMN patients aged more than 24 years were randomly selected as control group. Results 33 adolescent IMN patients were aged (20 卤3) years at the time of renal biopsy, male / female ratio 22 / 11, systolic blood pressure (127 卤13) mm Hg (1 mm Hg=0.133 k Pa),) diastolic blood pressure (77 卤9) mm Hg,24 hour urinary protein median 5.14 (3.39 卤9.31) g / d, serum creatinine 62 (52773) 渭 mol/L, serum anti-phospholipase A2 receptor antibody positive rate 54. Compared with the control group, the incidence of hypertension and the baseline estimated glomerular filtration rate were significantly different [15.2% vs 39.3%, 蠂 ~ 2 4.889 ml/ (min 1.73m~2) vs 100 ml/ (min 1.73m~2), UG137.5% P0.001]. There were 1 stage 鈪，
本文编号：2265310
[Abstract]:Objective to investigate the clinicopathological features and renal prognosis of adolescent idiopathic membranous nephropathy (IMN). Methods from June 2012 to December 2014, the patients with IMN diagnosed by renal biopsy from June 2012 to December 2014 were studied retrospectively. The secondary etiology of membranous nephropathy was excluded and the clinical and pathological data were collected. Thirty-three IMN patients aged more than 24 years were randomly selected as control group. Results 33 adolescent IMN patients were aged (20 卤3) years at the time of renal biopsy, male / female ratio 22 / 11, systolic blood pressure (127 卤13) mm Hg (1 mm Hg=0.133 k Pa),) diastolic blood pressure (77 卤9) mm Hg,24 hour urinary protein median 5.14 (3.39 卤9.31) g / d, serum creatinine 62 (52773) 渭 mol/L, serum anti-phospholipase A2 receptor antibody positive rate 54. Compared with the control group, the incidence of hypertension and the baseline estimated glomerular filtration rate were significantly different [15.2% vs 39.3%, 蠂 ~ 2 4.889 ml/ (min 1.73m~2) vs 100 ml/ (min 1.73m~2), UG137.5% P0.001]. There were 1 stage 鈪，
本文编号：2265310
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