特發(fā)性膜性腎病的臨床病理特征和診治研究
發(fā)布時(shí)間：2018-09-01 14:09
【摘要】：【目的】本研究將分析特發(fā)性膜性腎�。↖MN）的臨床病理表現(xiàn)、診斷與治療，以進(jìn)一步提高本病的診治水平。 【方法】1）收集2009.01-2013.10我科腎穿確診IMN患者共475例，比較其各項(xiàng)指標(biāo)并分析其臨床與病理聯(lián)系。2）對(duì)2010.03-2012.09經(jīng)腎臟病理活檢確診的IMN患者212例和V型及V型合并其他類型狼瘡性腎炎（MLN）患者28例的腎組織進(jìn)行IgG亞型免疫熒光檢測(cè)并進(jìn)行比較。3）回顧性分析2008.04-2013.02我科68例采用不同治療方法（激素聯(lián)合CsA或CTX），并隨訪一年以上的IMN患者。分析、比較兩組患者的治療效果及不良事件。 【結(jié)果】1）5年間IMN發(fā)病率呈上升趨勢(shì)。475例患者男女比例1.11:1，平均年齡53.0±14.9歲。不同年齡分組的IMN患者心血管危險(xiǎn)因素隨年齡升高趨于嚴(yán)重，表現(xiàn)為血紅蛋白下降、空腹血糖上升、收縮壓及舒張壓的升高（P均0.01）。腎組織免疫熒光以IgG（97.2%）及C3（73.6%）沉積為主，病理分期則以I期（25.3%）及II期（58.3%）為主，III期（15.6%）及IV期（0.8%）相對(duì)較少。2）IMN不同病理分期IgG亞型分布的百分比無(wú)明顯差異，均以IgG4沉積為主（I期100%、II期93.8%、III期85.7%）；非NS組的IgG3（P=0.013）及IgG4（P=0.02）亞型沉積熒光平均強(qiáng)度均高于NS組；MLN患者腎組織活檢沉積以非IgG4沉積為主，其所有IgG亞型沉積熒光平均強(qiáng)度與IMN患者相比有顯著差異性（P均0.001）。3）兩種治療方法均能有效降低IMN患者蛋白尿及升高血漿白蛋白，CsA組短期（3月）的緩解率高于CTX組，但隨訪1年的兩組緩解率無(wú)明顯差異（85.2%vs75.0%，P=0.212）。CsA組隨訪1年的eGFR較基線值顯著降低（104.1±31.7vs82.9±26.8ml/min/1.73m2，P0.001）。CsA組患者有5例在治療期間出現(xiàn)糖耐量受損/糖尿病；CTX組1例患者糖耐量受損，2例患者發(fā)生嚴(yán)重的肺部感染，其中1例合并急性腎盂腎炎。 【結(jié)論】IMN是一種常見(jiàn)的腎臟病，以中老年人多見(jiàn)，，男性多于女性。不同年齡段IMN患者有各自的臨床特征；IMN腎組織以IgG4沉積為主，而MLN以非IgG4為主。腎組織IgG亞型檢測(cè)有助于兩者的鑒別；激素聯(lián)合CsA或CTX均能有效緩解IMN患者病情。CsA可能會(huì)使腎功能減退，而CTX可能會(huì)誘發(fā)感染事件，這些副作用需要引起臨床醫(yī)生的注意。
[Abstract]:[objective] to analyze the clinicopathological features, diagnosis and treatment of idiopathic membranous nephropathy (IMN) in order to further improve the diagnosis and treatment of this disease. [methods] 1) 475 patients with IMN diagnosed by renal puncture in our department from January to March 2010 were collected. Comparing its indexes and analyzing its clinical and pathological relation .2) the renal tissues of 212 IMN patients diagnosed by renal pathological biopsy and 28 patients with (MLN) of V type and V type associated with other types of lupus nephritis were examined with IgG subtype immunofluorescence from 2010.03-2012.09. A retrospective analysis of 68 patients with IMN who were treated with different treatments (hormone combined with CsA or CTX),) from April to March, 2008.04-2013.The patients were followed up for more than one year. The therapeutic effect and adverse events of the two groups were compared. [results] 1) the incidence of IMN increased in 5 years. The ratio of male to female was 1.11: 1 with an average age of 53.0 鹵14.9 years. The cardiovascular risk factors of IMN patients in different age groups tended to be serious with the increase of age, such as the decrease of hemoglobin, the increase of fasting blood glucose, and the increase of systolic and diastolic blood pressure (P0.01). IgG (97.2%) and C3 (73.6%) were mainly deposited in renal tissues, while the percentage of IgG subtypes in different stages of IMN was not significantly different among stages I (25.3%), II (58.3%), III (15.6%) and IV (0.8%). The average intensity of IgG4 deposition in IgG3 (P0. 013) and IgG4 (P0. 02) subtypes in non NS group was higher than that in NS group. The average fluorescence intensity of deposition of all IgG subtypes was significantly different from that of IMN patients (P all 0.001). Both of the two treatments could effectively reduce proteinuria and increase the remission rate of short term (3 months) in IMN patients with elevated plasma albumin CSA compared with those in CTX group. But there was no significant difference in remission rate between the two groups (85.2 vs 75.0 and P0.212). The eGFR of CSA group was significantly lower than the baseline value (104.1 鹵26.8ml / min / 1.73m2P0.001). Five patients in CSA group had impaired glucose tolerance / diabetes during treatment. In CTX group, one patient with impaired glucose tolerance and two patients with severe pulmonary infection developed severe pulmonary infection. [conclusion] IMN is a common renal disease, most of which are middle and old people, male is more than female. Different age groups of IMN patients had their own clinical features: IgG4 deposition was the main renal tissue, and MLN was non-IgG4. The detection of IgG subtypes in renal tissue is helpful for the differentiation of the two, and hormone combined with CsA or CTX can effectively alleviate the renal dysfunction in patients with IMN, while CTX may induce infection events, these side effects need the attention of clinicians.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
[Abstract]:[objective] to analyze the clinicopathological features, diagnosis and treatment of idiopathic membranous nephropathy (IMN) in order to further improve the diagnosis and treatment of this disease. [methods] 1) 475 patients with IMN diagnosed by renal puncture in our department from January to March 2010 were collected. Comparing its indexes and analyzing its clinical and pathological relation .2) the renal tissues of 212 IMN patients diagnosed by renal pathological biopsy and 28 patients with (MLN) of V type and V type associated with other types of lupus nephritis were examined with IgG subtype immunofluorescence from 2010.03-2012.09. A retrospective analysis of 68 patients with IMN who were treated with different treatments (hormone combined with CsA or CTX),) from April to March, 2008.04-2013.The patients were followed up for more than one year. The therapeutic effect and adverse events of the two groups were compared. [results] 1) the incidence of IMN increased in 5 years. The ratio of male to female was 1.11: 1 with an average age of 53.0 鹵14.9 years. The cardiovascular risk factors of IMN patients in different age groups tended to be serious with the increase of age, such as the decrease of hemoglobin, the increase of fasting blood glucose, and the increase of systolic and diastolic blood pressure (P0.01). IgG (97.2%) and C3 (73.6%) were mainly deposited in renal tissues, while the percentage of IgG subtypes in different stages of IMN was not significantly different among stages I (25.3%), II (58.3%), III (15.6%) and IV (0.8%). The average intensity of IgG4 deposition in IgG3 (P0. 013) and IgG4 (P0. 02) subtypes in non NS group was higher than that in NS group. The average fluorescence intensity of deposition of all IgG subtypes was significantly different from that of IMN patients (P all 0.001). Both of the two treatments could effectively reduce proteinuria and increase the remission rate of short term (3 months) in IMN patients with elevated plasma albumin CSA compared with those in CTX group. But there was no significant difference in remission rate between the two groups (85.2 vs 75.0 and P0.212). The eGFR of CSA group was significantly lower than the baseline value (104.1 鹵26.8ml / min / 1.73m2P0.001). Five patients in CSA group had impaired glucose tolerance / diabetes during treatment. In CTX group, one patient with impaired glucose tolerance and two patients with severe pulmonary infection developed severe pulmonary infection. [conclusion] IMN is a common renal disease, most of which are middle and old people, male is more than female. Different age groups of IMN patients had their own clinical features: IgG4 deposition was the main renal tissue, and MLN was non-IgG4. The detection of IgG subtypes in renal tissue is helpful for the differentiation of the two, and hormone combined with CsA or CTX can effectively alleviate the renal dysfunction in patients with IMN, while CTX may induce infection events, these side effects need the attention of clinicians.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 宦紅娣,張景紅,劉志紅,黎磊石,陳惠萍,鄭豐;成人特發(fā)性膜性腎病264例的臨床與病理分析[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2001年03期
2 梁繼紅;朱春玲;陳佳;;60例狼瘡性腎炎的臨床與病理[J];貴陽(yáng)醫(yī)學(xué)院學(xué)報(bào);2011年04期
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