84例膜性肾病回顾性分析及HCMV、EBV感染的初步观察
发布时间：2018-07-13 15:36
【摘要】：目的： 1.通过分析不典型膜性肾病与特发性膜性肾病的临床表现，实验室检测及肾脏病理上的特征，探讨其临床和肾脏病理的特点，为诊断及治疗不典型膜性肾病提供依据。 2.研究EB病毒(EBV)、人巨细胞病毒(HCMV)在不典型膜性肾病与特发性膜性肾病患者肾组织中的表达情况，以探讨HCMV，EBV感染与不典型膜性肾病的发生、发展的关系，为不典型膜性肾病发病机制的研究和治疗提供新的线索。 方法： 回顾性的分析2011年1月~2012年12月就诊于山西医科大学第二医院肾内科经肾穿活检术后由电镜确诊为膜性肾病的84例患者（其中包括不典型膜性肾病44例，特发性膜性肾病40例）的完整临床及病理资料。利用核酸原位杂交技术检测膜性肾病患者肾组织内EB病毒(EBV)及人巨细胞病毒(HCMV)的感染情况。 结果： 1.不典型膜性肾病患者中男性25例，女性19例，男女比例为1.32:1;发病年龄17~60岁，平均（31.42士14.5)岁；特发性膜性肾病患者中男性26例，女性14例，男女比例为1.85:1;发病年龄42~70岁，，平均（51.08士6.74）岁。两组性别构成比无统计学差异(P0.05)，两组发病年龄有明显统计学差异（P0.05），不典型膜性肾病发病年龄主要在30岁左右，而特发性膜性肾病发病年龄在40岁以上。 2.44例不典型膜性肾病患者中，34例(77.8%)表现为肾病综合征，4例(9.1%）患者伴有肾功能不全，32例(72.2%)患者伴有镜下血尿，12例（27.8%)患者伴有高血压。40例特发性膜性肾病患者中，27例(66.7%)表现为肾病综合征，3例(7.5%）患者伴有肾功能不全，18例(45.8%)患者伴有镜下血尿，6例（24.3%)患者伴有高血压。两者都以肾病综合征表现为主，且二者肾病综合征的构成比差异无统计学意义(P0.05)。伴有肾功能不全及高血压构成比差异也无统计学差异，不典型膜性肾病镜下血尿发生率高于膜性肾病，有统计学差异。 3.特发性膜性肾病免疫荧光主要以IgG和C3沉积为主，分别为40例(100%)和25例(62.5%），可见IgA沉积者14例(35.0%)、 IgM19例(47.5%)、C1q10例（25.0%）、FRA23例（57.5%）；不典型膜性肾病免疫荧光IgG和C3沉积为主，分别为44例(100%)和33例（75.0%），可见IgA沉积者26例(59.1%)、 IgM35例(79.54%)、C1q35例（79.54%）、FRA27例（61.4%）。两者免疫荧光比较，均以IgG、C3沉积为主，两者之间无统计学差异；FRA的沉积亦无统计学差异；不典型膜性肾病与特发性膜性肾病相比， Clq、IgA及IgM沉积明显增多，有统计学差异（P0.05）。 4.40例特发性膜性肾病肾组织中，10例(25%) EB病毒阳性，30例(75%）EB病毒阴性；44例不典型膜性肾病肾组织中，检测结果显示：16例(36%)EB病毒阳性，28例(64%）EB病毒阴性，卡方检验统计结果：两者无统计学差异（P0.05） 5.40例特发性膜肾性肾病组织中，25例(63%) HCMV病毒阳性，15例(37%）EB病毒阴性；44例不典型膜性肾病肾组织中，检测结果显示：40例(90%)HCMV病毒阳性，4例(10%）HCMV病毒阴性，卡方检验统计结果：两者有统计学差异（P0.05）。 6.40例特发性膜肾组织中，12例(30%) HCMV病毒与EBV病毒同时阳性，44例不典型膜肾组织中，10例(20.8%)HCMV病毒与EBV病毒同时阳性，卡方检验统计结果：两者无统计学差异（P0.05）。 结论： 1.不典型膜性肾病发病年龄主要在30岁左右，与特发性膜性肾病在发病年龄上差异显著，而性别构成比无差别。 2.不典型膜性肾病镜下血尿较特发性膜性肾病发病率高。 3.不典型膜性肾病与特发性膜性肾病相比，肾脏病理特点有Clq、IgA及IgM沉积明显增多，有统计学差异（P0.05）。不典型膜性肾病的Clq、IgA及IgM沉积率高于特发性膜性肾病。 4.不典型膜性肾病与特发性膜性肾病相比，两者EB病毒阳性率比较无统计学差异。 5.肾组织中HCMV在膜性肾病中有较高的阳性率，且不典型膜性肾病阳性率更高，与特发性膜性肾病相比有统计学差异。
[Abstract]:Objective:
1. the clinical and renal pathological features of atypical membranous nephropathy and idiopathic membranous nephropathy were analyzed to provide evidence for the diagnosis and treatment of atypical membranous nephropathy.
2. to investigate the expression of EB virus (EBV) and human cytomegalovirus (HCMV) in the renal tissue of patients with atypical membranous nephropathy and idiopathic membranous nephropathy, in order to explore the relationship between the occurrence and development of HCMV, EBV infection and atypical membranous nephropathy, and provide new clues for the research and treatment of the pathogenesis of atypical membranous nephropathy.
Method:
A retrospective analysis of the complete clinical and pathological materials in 84 patients (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy) diagnosed in the second hospital of Shanxi Medical University, January 2011 ~2012 in the nephrology of Shanxi Medical University after renal biopsy by electron microscopy (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy). The infection of EB virus (EBV) and human cytomegalovirus (HCMV) in renal tissue of patients.
Result:
1. of the patients with atypical membranous nephropathy, there were 25 males and 19 females, with a male and female ratio of 1.32:1; the age of onset was 17~60 years, and the average (31.42 and 14.5) years of age; 26 of males and 14 women in women with idiopathic membranous nephropathy; the male and female ratio was 1.85:1; the age of onset was 42~70 years, and the average (51.08 and 6.74) years old. There was no statistical difference in the sex composition of two groups (P0.05) and two groups. The age of onset was significantly different (P0.05), the age of onset of atypical membranous nephropathy was mainly about 30 years old, and the onset age of idiopathic membranous nephropathy was more than 40 years old.
Of the 2.44 patients with atypical membranous nephropathy, 34 (77.8%) showed nephrotic syndrome, 4 (9.1%) patients with renal insufficiency, 32 (72.2%) accompanied by microscopic hematuria, 12 (27.8%) patients with.40 cases of idiopathic membranous nephropathy, 27 (66.7%) with nephrotic syndrome, 3 (7.5%) patients with renal insufficiency, 18 Cases (45.8%) were accompanied by microscopic hematuria, and 6 (24.3%) patients were accompanied by hypertension. Both were mainly nephrotic syndrome, and the proportion of the two nephrotic syndrome was not statistically significant (P0.05). There was no statistical difference in the difference of renal function and hypertension, and the incidence of hematuria in the atypical membranous nephropathy was higher than that of the membrane. There were statistical differences in sexual kidney disease.
3. the main immunofluorescence of idiopathic membranous nephropathy was mainly IgG and C3 deposition, 40 cases (100%) and 25 cases (62.5%), 14 cases (35%), IgM19 cases (47.5%), C1q10 cases (25%), and FRA23 cases (57.5%). The immunofluorescent IgG and C3 deposition of atypical membranous nephropathy were mainly in 44 (100%) and 33 cases respectively, and IgA depositing cases were seen respectively. .1%), IgM35 cases (79.54%), C1q35 cases (79.54%) and FRA27 cases (61.4%). The immunofluorescence was compared with IgG and C3 deposition, and there was no statistical difference between the two. The deposition of FRA was not statistically different. Compared with the idiopathic membranous nephropathy, the deposition of Clq, IgA and IgM was significantly increased, and there were statistical differences (P0.05).
In 4.40 cases of idiopathic membranous nephropathy, 10 cases (25%) EB virus positive, 30 (75%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 16 cases (36%) EB virus positive, 28 cases (64%) EB virus negative, chi square test statistical results: there was no statistical difference between the two (P0.05)
In 5.40 cases of idiopathic nephrotic nephropathy, 25 cases (63%) HCMV virus positive and 15 (37%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 40 cases (90%) HCMV virus positive, 4 cases (10%) HCMV virus negative, chi square test statistical results: the statistical difference between the two (P0.05).
In 6.40 cases of idiopathic membranous renal tissue, 12 cases (30%) HCMV virus and EBV virus were simultaneously positive, 44 cases of atypical membrane kidney tissue, 10 cases (20.8%) HCMV virus and EBV virus simultaneously positive, chi square test statistical results: there was no statistical difference (P0.05).
Conclusion:
1. the age of onset of atypical membranous nephropathy is mainly around 30 years old. There is a significant difference in age at onset between idiopathic membranous nephropathy and idiopathic membranous nephropathy.
2. the incidence of hematuria in patients with atypical membranous nephropathy is higher than that in idiopathic membranous nephropathy.
3. compared with idiopathic membranous nephropathy, 3. atypical membranous nephropathy was characterized by renal pathological features, IgA and IgM deposits were significantly increased (P0.05). The Clq, IgA and IgM deposition rates of atypical membranous nephropathy were higher than that of idiopathic membranous nephropathy.
4. compared with idiopathic membranous nephropathy, there was no significant difference in the positive rate of EB virus between atypical membranous nephropathy and idiopathic membranous nephropathy.
5. in renal tissue, HCMV has a high positive rate in membranous nephropathy, and the positive rate of atypical membranous nephropathy is higher than that of idiopathic membranous nephropathy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692
本文编号：2119906
[Abstract]:Objective:
1. the clinical and renal pathological features of atypical membranous nephropathy and idiopathic membranous nephropathy were analyzed to provide evidence for the diagnosis and treatment of atypical membranous nephropathy.
2. to investigate the expression of EB virus (EBV) and human cytomegalovirus (HCMV) in the renal tissue of patients with atypical membranous nephropathy and idiopathic membranous nephropathy, in order to explore the relationship between the occurrence and development of HCMV, EBV infection and atypical membranous nephropathy, and provide new clues for the research and treatment of the pathogenesis of atypical membranous nephropathy.
Method:
A retrospective analysis of the complete clinical and pathological materials in 84 patients (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy) diagnosed in the second hospital of Shanxi Medical University, January 2011 ~2012 in the nephrology of Shanxi Medical University after renal biopsy by electron microscopy (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy). The infection of EB virus (EBV) and human cytomegalovirus (HCMV) in renal tissue of patients.
Result:
1. of the patients with atypical membranous nephropathy, there were 25 males and 19 females, with a male and female ratio of 1.32:1; the age of onset was 17~60 years, and the average (31.42 and 14.5) years of age; 26 of males and 14 women in women with idiopathic membranous nephropathy; the male and female ratio was 1.85:1; the age of onset was 42~70 years, and the average (51.08 and 6.74) years old. There was no statistical difference in the sex composition of two groups (P0.05) and two groups. The age of onset was significantly different (P0.05), the age of onset of atypical membranous nephropathy was mainly about 30 years old, and the onset age of idiopathic membranous nephropathy was more than 40 years old.
Of the 2.44 patients with atypical membranous nephropathy, 34 (77.8%) showed nephrotic syndrome, 4 (9.1%) patients with renal insufficiency, 32 (72.2%) accompanied by microscopic hematuria, 12 (27.8%) patients with.40 cases of idiopathic membranous nephropathy, 27 (66.7%) with nephrotic syndrome, 3 (7.5%) patients with renal insufficiency, 18 Cases (45.8%) were accompanied by microscopic hematuria, and 6 (24.3%) patients were accompanied by hypertension. Both were mainly nephrotic syndrome, and the proportion of the two nephrotic syndrome was not statistically significant (P0.05). There was no statistical difference in the difference of renal function and hypertension, and the incidence of hematuria in the atypical membranous nephropathy was higher than that of the membrane. There were statistical differences in sexual kidney disease.
3. the main immunofluorescence of idiopathic membranous nephropathy was mainly IgG and C3 deposition, 40 cases (100%) and 25 cases (62.5%), 14 cases (35%), IgM19 cases (47.5%), C1q10 cases (25%), and FRA23 cases (57.5%). The immunofluorescent IgG and C3 deposition of atypical membranous nephropathy were mainly in 44 (100%) and 33 cases respectively, and IgA depositing cases were seen respectively. .1%), IgM35 cases (79.54%), C1q35 cases (79.54%) and FRA27 cases (61.4%). The immunofluorescence was compared with IgG and C3 deposition, and there was no statistical difference between the two. The deposition of FRA was not statistically different. Compared with the idiopathic membranous nephropathy, the deposition of Clq, IgA and IgM was significantly increased, and there were statistical differences (P0.05).
In 4.40 cases of idiopathic membranous nephropathy, 10 cases (25%) EB virus positive, 30 (75%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 16 cases (36%) EB virus positive, 28 cases (64%) EB virus negative, chi square test statistical results: there was no statistical difference between the two (P0.05)
In 5.40 cases of idiopathic nephrotic nephropathy, 25 cases (63%) HCMV virus positive and 15 (37%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 40 cases (90%) HCMV virus positive, 4 cases (10%) HCMV virus negative, chi square test statistical results: the statistical difference between the two (P0.05).
In 6.40 cases of idiopathic membranous renal tissue, 12 cases (30%) HCMV virus and EBV virus were simultaneously positive, 44 cases of atypical membrane kidney tissue, 10 cases (20.8%) HCMV virus and EBV virus simultaneously positive, chi square test statistical results: there was no statistical difference (P0.05).
Conclusion:
1. the age of onset of atypical membranous nephropathy is mainly around 30 years old. There is a significant difference in age at onset between idiopathic membranous nephropathy and idiopathic membranous nephropathy.
2. the incidence of hematuria in patients with atypical membranous nephropathy is higher than that in idiopathic membranous nephropathy.
3. compared with idiopathic membranous nephropathy, 3. atypical membranous nephropathy was characterized by renal pathological features, IgA and IgM deposits were significantly increased (P0.05). The Clq, IgA and IgM deposition rates of atypical membranous nephropathy were higher than that of idiopathic membranous nephropathy.
4. compared with idiopathic membranous nephropathy, there was no significant difference in the positive rate of EB virus between atypical membranous nephropathy and idiopathic membranous nephropathy.
5. in renal tissue, HCMV has a high positive rate in membranous nephropathy, and the positive rate of atypical membranous nephropathy is higher than that of idiopathic membranous nephropathy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692
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