膜性肾病的临床及病理特点分析

发布时间：2018-06-25 23:56

本文选题：肾病综合征 + 膜性肾病　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的通过分析65例经肾活检诊断为膜性肾病患者的临床及病理资料,探讨膜性肾病的临床及病理特点,为临床正确诊断、治疗、评估预后等提供更多理论依据;同时增进对不典型膜性肾病的认识。方法收集宁夏回族自治区人民医院肾内科2011年11月至2016年12月行肾穿刺活检诊断为膜性肾病的65例患者的病例资料:包括一般情况,实验室检查:血常规、尿常规、24小时尿蛋白、尿红细胞形态、肝肾功能、血脂、免疫指标、肝炎全套,肾脏彩超,病理资料:膜性肾病病理分型及分期、肾小球硬化情况、新月体个数、系膜增生、肾小管萎缩、肾间质纤维化、肾动脉增厚情况,免疫荧光沉积部位、种类及强弱等。并根据不同性别、年龄、24小时蛋白尿、eGFR、血尿及病理类型进行分组,统计分析比较不同组间患者的临床及病理资料特点。同时用免疫组化方法检测肾组织M型磷脂酶A2受体(PLA2R)在膜性肾病患者的表达情况。结果1、一般资料及临床资料分析:65例膜性肾病患者的年龄为(50.5±14.5)岁,以中老年多见,男41例,女24例,男女性别比1.71:1。以浮肿就诊者最为多见,为49例(75.4%),临床表现主要为肾病综合征的50例(76.9%),伴血尿者54例(83.1%),其中1例表现为肉眼血尿,伴高血压者19例(29.2%),高脂血症者60例(92.3%),肾功能下降者25例(38.5%)。2.不同分组间临床及病理资料分析:(1)不同性别组比较:两组间在临床表现上无明显差异,但在不同病理类型中存在差异,男性患者多以特发性膜性肾病为主(68.3%VS 37.5%),女性患者多以不典型膜性肾病为主(50%VS 19.5%)(P0.05)。(2)不同年龄组间比较:各年龄组均以男性发病多见,老年组较青年组具有较低的eGFR和更高的高血压发生率(P0.01)。(3)不同程度蛋白尿组间比较:随着24小时尿蛋白的增加,血浆白蛋白水平较低,肌酐水平较高;大量蛋白尿组患者胆固醇水平较高、eGFR较低(P0.05)。(4)不同eGFR组间比较:与肾功能正常组相比,肾功能下降组患者具有年龄较大、基础血肌酐水平较高的特点,差异有统计学意义(P0.01)。(5)有无血尿组间比较:有血尿者比无血尿组发病年龄低,差异有统计学意义(P0.05)。3、病理资料分析:特发膜性肾病37例(56.9%),其中I期、II期、I-II期膜性肾病分别为22例(59.5%)、11例(29.7%)、4例(10.8%),无III期及IV期患者。不典型膜性肾病20例(30.8%),继发膜性肾病8例(12.3%),以乙肝相关性膜性肾病最为多见,6例(75.0%),2例狼疮性肾炎(25.0%)。免疫荧光以IgG沉积为主,65例(100%)。不典型膜性肾病及继发性膜性肾病较特发性膜性肾病有更高的系膜增生率及IgA、C1q沉积率(P0.01)。特发性膜性肾病男性发病率高于不典型膜性肾病(P0.05),继发性膜性肾病患者较特发性膜性肾病患者有较低的白蛋白水平(P0.05)。4、PLA2R在膜性肾病患者肾组织中的表达情况:PLA2R在IMN、AMN、SMN中的阳性率分别为90.6%、93.3%、42.9%,经组间比较显示IMN及AMN较SMN有较高的PLA2R阳性率,差异有统计学意义(P=0.014),SMN中HBV-MN阳性率较高,为60.0%。结论膜性肾病好发于中老年男性患者,临床表现以肾病综合征多见。高龄及大量蛋白尿为膜性肾病肾功能进展的危险因素。不典型膜性肾病的发病率较高,而且PLA2R在不典型膜性肾病中阳性率和在特发性膜性肾病一样高。
[Abstract]:Objective to analyze the clinical and pathological data of 65 patients with membranous nephropathy diagnosed by renal biopsy, to explore the clinical and pathological features of membranous nephropathy, and to provide more theoretical basis for the correct diagnosis, treatment and evaluation of prognosis, and to improve the understanding of atypical membranous nephropathy. Methods collect the nephrology department of the people's Hospital of the Ningxia Hui Autonomous Region. From November 2011 to December 2016, 65 cases of membranous nephropathy were diagnosed by renal biopsy: general condition, laboratory examination: blood routine, urine routine, 24 hour urine protein, urine red cell morphology, liver and kidney function, blood lipid, immune index, hepatitis whole set, kidney color Doppler, pathological data: membranous nephrosis pathological classification and staging, kidney The case of sclerotherapy, the number of crescent crescent, mesangial hyperplasia, renal tubule atrophy, renal interstitial fibrosis, renal artery thickening, immunofluorescence site, type and strength, etc. were divided according to different sex, age, 24 hours proteinuria, eGFR, hematuria and pathological type, and compared the clinical and pathological data of patients with different groups. At the same time, the expression of M type phospholipase A2 receptor (PLA2R) in renal tissue was detected by immunohistochemical method. Results 1, general data and clinical data analysis: 65 cases of membranous nephropathy were (50.5 + 14.5) years old, middle-aged and old, male 41, female 24, and sex ratio of male and female to swollen patients was the most common, 49, 49. 49 Cases (75.4%), the clinical manifestations were mainly nephrotic syndrome in 50 cases (76.9%) and 54 cases of hematuria (83.1%), including 1 cases with naked hematuria, 19 patients with hypertension (29.2%), 60 patients with hyperlipidemia (92.3%), 25 (38.5%) renal function decline (38.5%).2. different groups of clinical and pathological data analysis: (1) different sex groups in clinical tables between different groups There was no significant difference at present, but in different pathological types, male patients were mostly with idiopathic membranous nephropathy (68.3%VS 37.5%), female patients were mostly with atypical membranous nephropathy (50%VS 19.5%) (P0.05). (2) the comparison between different age groups: all age groups are more common in males and lower eGFR in the older group than in the young group. Higher incidence of hypertension (P0.01). (3) compared with different levels of proteinuria, plasma albumin level was lower and creatinine level was higher with the increase of 24 hours urine protein; the levels of cholesterol in the large albuminuria group were higher, and the eGFR was lower (P0.05). (4) the comparison of different eGFR groups: compared with the normal renal function group, the patients with the renal function decline group have a higher level of renal function. There was a higher age and higher level of basic blood creatinine (P0.01). (5) compared with or without hematuria, there was a lower incidence of hematuria than that in the non hematuria group, the difference was statistically significant (P0.05).3, pathological data analysis: 37 cases of idiopathic nephrotic disease (56.9%), of which 22 cases (59.5%) were I, II, and I-II membranous nephropathy, 1 1 (29.7%), 4 (10.8%), no III and IV, 20 cases of atypical membranous nephropathy (30.8%), 8 cases of membranous nephropathy (12.3%), the most common of hepatitis B related membranous nephropathy, 6 (75%), 2 lupus nephritis (25%). Immunofluorescence was mainly IgG deposition, 65 cases (100%). Atypical membranous nephropathy and secondary membranous nephropathy were more idiopathic membranous nephropathy. The rate of mesangial hyperplasia and IgA, C1q deposition rate (P0.01). The incidence of idiopathic membranous nephropathy in men is higher than that of atypical membranous nephropathy (P0.05). Secondary membranous nephropathy has a lower albumin level (P0.05).4 than that of idiopathic membranous nephropathy (P0.05), and the expression of PLA2R in the renal tissue of patients with membranous nephropathy: PLA2R in IMN, AMN, S. The positive rates in MN were 90.6%, 93.3% and 42.9% respectively. Compared with SMN, the positive rate of IMN and AMN was higher than that of SMN. The difference was statistically significant (P=0.014), the positive rate of HBV-MN in SMN was higher. The risk factors for the progression of renal renal function. The incidence of atypical membranous nephropathy is higher, and the positive rate of PLA2R in atypical membranous nephropathy is as high as that of idiopathic membranous nephropathy.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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