特发性膜性肾病临床病理特点及预后研究

发布时间：2019-02-15 19:54

【摘要】：目的:探讨特发性膜性肾病(Idiopathic membranous nephropathy,iMN)患者临床病理特点,并对预后影响因素进行分析。方法:本研究纳入2010年1月至2015年3月在新疆自治区人民医院住院并经肾活检诊断为iMN患者。依据估算的肾小球滤过率(Estimated glomerular filtration rate,eGFR)和尿蛋白基线水平分别分组,对临床病理资料进行统计分析;对随访患者按照是否达到随访终点进行分组,绘制ROC曲线,根据ROC确定的指标阈值进行分组,将达到随访终点的百分率采用Kaplan Meier曲线评估,采用Cox风险比例回归模型探讨预后影响因素。结果:(1)总计241例患者入选,男性171例(70.9%),女性70例(29.1%),男、女之比约为2.4∶1,所有患者均有不同程度的蛋白尿,其中大量蛋白尿有25例(10.4%);随访过程中,27例(45%)患者发生尿蛋白缓解;(2)不同阶段的eGFR患者组间相比,在血白蛋白(albumin,Alb)、尿β2微球蛋白(beta2-microglobulin,β2-MG)、局灶节段性肾小球硬化(focal segmental glomurular sclerosis,FSGS)及肾小管间质损害指标上差异均具有统计学意义,在血尿和肾脏小血管病变指标上组间差异均未见统计学意义;(3)不同水平的24小时尿蛋白组间比较,在吸烟及eGFR指标上差异均具有统计学意义;(4)多因素分析,年龄、大量蛋白尿、尿IgG、尿β2-MG及肾小管间质损害对肾功能影响具有统计学意义,95%CI分别为(1.056,1.158)、(1.904,2.245)、(1.008,1.075)、(0.491,1.979)及(0.163,1.146);(5)预后影响因素分析得出尿β2-MG、尿IgG具有统计学意义,P值分别为0.046和0.003,95%CI分别为1.105~1.137和1.015~1.076。结论:(1)iMN以男性多见,部分患者可以发生尿蛋白缓解;(2)所有患者均有不同程度的蛋白尿,男性、吸烟、低血白蛋白浓度、病理分期高、病程较长的iMN患者,尿蛋白排泄增多,肾功能下降明显;(3)尿β2-MG、尿IgG在对疾病的预后评估上有一定的价值,并且为影响肾功能下降的独立危险因素。
[Abstract]:Objective: to investigate the clinicopathological features and prognostic factors of idiopathic membranous nephropathy (Idiopathic membranous nephropathy,iMN). Methods: from January 2010 to March 2015, we were hospitalized in Xinjiang people's Hospital and diagnosed as iMN by renal biopsy. According to the estimated glomerular filtration rate (Estimated glomerular filtration rate,eGFR) and the baseline level of urinary protein, the clinicopathological data were statistically analyzed. The follow-up patients were divided into groups according to whether they reached the end point of follow-up, and the ROC curve was drawn, and the percentage of the patients who reached the end of follow-up was assessed by Kaplan Meier curve according to the index threshold determined by ROC. Cox risk proportional regression model was used to study the prognostic factors. Results: (1) A total of 241 patients were enrolled, 171 males (70.9%) and 70 females (29.1%). The ratio of male to female was about 2.4: 1. There were 25 cases (10.4%) with massive proteinuria. During follow-up, urinary protein remission occurred in 27 patients (45%). (2) comparison of serum albumin (albumin,Alb), urinary 尾 2-microglobulin (beta2-microglobulin, 尾 2-MG), focal segmental glomerulosclerosis (focal segmental glomurular sclerosis,) between different stages of eGFR patients FSGS) and renal tubulointerstitial lesion were statistically significant, but there was no significant difference in hematuria and renal microvascular lesion between the two groups. (3) there were significant differences in smoking and eGFR between 24 hour urine protein groups with different levels. (4) in multivariate analysis, age, macroalbuminuria, urinary IgG, urine 尾 2-MG and renal tubulointerstitial lesion had statistically significant effects on renal function, 95%CI were 1.056 卤1.158), (1.904), (2.245), (1.008 卤1.075, respectively. (0.491) and (0.163) 1.146; (5) the analysis of prognostic factors showed that urinary 尾 _ 2-MG and urinary IgG had statistical significance, P = 0.046 and 0.003 ~ 95 CI = 1.105 ~ 1.137 and 1.015 ~ 1.076, respectively. Conclusion: (1) iMN is more common in men, and some patients may have urinary protein remission; (2) all patients had different degree of proteinuria, male, smoking, low serum albumin concentration, high pathological stage, long course of iMN patients, urinary protein excretion increased, renal function decreased significantly; (3) urinary 尾 2-MGand urinary IgG have certain value in evaluating the prognosis of the disease, and they are independent risk factors for the decline of renal function.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692

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