青年人特发性膜性肾病临床及病理特点分析

发布时间：2018-07-27 13:02

【摘要】：目的研究青年特发性膜性肾病(IMN)的临床及病理特点。方法纳入首都医科大学附属北京安贞医院2012年1月至2016年9月经肾穿刺病理检查诊断为IMN的病例,比较≤35岁(A组)和35岁(B组)IMN患者的临床、病理表现及治疗效果。结果 (1)IMN患者537例,占同期肾活检病例的25.8%及原发性肾小球疾病的32.5%,其中A组占IMN的20.9%。(2)与B组比较,A组患者病程较短,呈肾病综合征及肾功能不全的比例较低,而呈无症状性蛋白尿的比例较高(P0.05);此外,A组患者伴发肥胖、糖尿病、高血压的比例较低(P0.05或P0.01)。(3)肾小球毛细血管壁上Ig G4亚类及PLA2R沉积的阳性率分别为95.0%及91.8%,A、B两组阳性率比较差异无统计学意义(P0.05)。11.4%肾小球无PLA2R沉积的患者中,肾小球THSD7A沉积阳性,A、B两组比较差异也无统计学意义(P0.05)。(4)两组患者的近期治疗疗效相似(P0.05)。结论青年IMN患者的肾小球内致病抗体与抗原沉积及治疗疗效与中老年患者相似,提示二者不存在实质性区别。两组患者的某些临床表现和治疗方案的不同可能为年龄因素及并发症所致。
[Abstract]:Objective to study the clinical and pathological features of young idiopathic membranous nephropathy (IMN). Methods the clinical, pathological and therapeutic effects were compared between 35 years old (group A) and 35 year old (group B) IMN patients who were diagnosed as IMN in Beijing An Zhen Hospital affiliated to Capital Medical University from January 2012 to 9 2016. Results (1) 537 IMN patients. Cases accounted for 25.8% of renal biopsy cases and 32.5% of primary glomerular diseases in the same period, of which group A accounted for 20.9%. (2) of IMN (2) compared with group B. The patients in group A had a shorter course of disease, a lower proportion of nephrotic syndrome and renal insufficiency (P0.05), and a higher proportion of asymptomatic proteinuria (P0.05); in addition, the A group was associated with obesity, diabetes, and high blood pressure. Lower (P0.05 or P0.01). (3) the positive rates of Ig G4 subclass and PLA2R deposition on the glomerular capillary wall were 95% and 91.8%, respectively, A, B two had no statistically significant difference (P0.05).11.4% glomerular non PLA2R deposition, glomerular THSD7A deposition was positive, A, two groups were not statistically significant. (4) two groups of patients The curative effect of the recent treatment was similar (P0.05). Conclusion the glomerular disease antibody and antigen deposition and therapeutic effect of the young IMN patients were similar to those of the middle aged and old patients, suggesting that there was no substantial difference between the two patients. The difference in some clinical manifestations and treatment schemes in the two groups may be caused by years of age and complications.
【作者单位】：首都医科大学附属北京安贞医院肾内科;武警总医院肾内科;赤峰学院附属医院肾内科;内蒙古兴安盟人民医院肾内科;
【基金】：北京市自然科学基金项目(7152048,7172066)
【分类号】：R692

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