目的 探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床特征与治疗策略。方法 收集2015-07至2017-06 河北大学附属医院行肾穿刺活检术明确诊断为IMN的336例患者的临床及肾脏病理资料,按照年龄分为青年组(<40岁)、中年组(40~60岁)、老年组(>60岁)3组;按照病理分期分为Ⅰ期、Ⅰ-Ⅱ期、Ⅱ期、Ⅱ-Ⅲ期及AMN共5组。回顾性分析患者的一般资料、临床表现,按年龄分组比较临床病理特征,比较不同病理分期的临床指标。结果 (1)336例中,城乡患者比例0.29∶1;农民283例,农民患者所占比例显著高于其他职业;春季94例(28.0%),夏季84例(25.0%),秋季82例(24.4%),冬季76例(22.6%),春季发病高于其他季节。(2)临床主要表现为肾病综合征和慢性肾炎综合征,伴高血压及镜下血尿者多见。(3)病理分期以Ⅰ期为主,占58.6%;63.1%的患者伴有肾小管-间质损害;免疫荧光显示,免疫复合物以IgG和C3沉积为主。(4)老年组与青中年组比较,伴高血压者较多,收缩压增高为主,且随年龄增高,eGFR逐渐下降;中年组伴镜下血尿者比例较高;三组患者舒张压、贫血、白蛋白、血肌酐、总胆固醇、三酰甘油、肾小球硬化积分差异无统计学意义。(5)随病理分期加重,贫血患者比例逐渐增多,肾小球硬化积分逐渐增高;各病理分期在男性比例、高血压比例、血尿、24 h尿蛋白定量、血白蛋白、血肌酐、eGFR上差异无统计学意义。结论 临床上更应重视老年、男性、大量蛋白尿、病理分期较高、伴有肾小管及间质纤维化IMN患者的治疗。

Objective To explore the clinical features and treatment of idiopathic membranous nephropathy (IMN).Methods The clinical and renal pathological data of 336 patients with IMN treated at the Affiliated Hospital of Hebei University between July 2015 and June 2017 was analyzed retrospectively.Results (1)Among the 336 cases of IMN patients, the ratio of urban patients to rural ones was 0.29∶1.283 of these patients were farmers, whose percentage was significantly higher than that of other occupations.This disease was more prevalent in spring than in other seasons.(2)IMN patients were characterized by nephrotic syndrome and chronic nephritis syndrome, with high blood pressure and microscopic hematuria.(3)Most of the patients were in stage 1 according to pathological staging, accounting for 58.6%. 63.1% of the patients had renal tubule-interstitial damage.Immunofluorescence showed that the immune complex was mainly formed by IgG and C₃.(4)Compared with the young and middle-aged groups, high blood pressure was more prevalent in the elder group. The proportion of hematuria in the middle-aged group was higher than in other groups.There was no statistically significant difference in diastolic blood pressure, anemia, albumin, serum creatinine, total cholesterol, triglyceride and glomerulosclerosis integrals between the three groups.(5)With the increase of pathological staging,the proportion of patients with anemia increased gradually, so did the glomerulosclerosis integral.There was no statistically significant difference between the pathological stages in the percentage of males, the proportion of hypertension, blood urine, 24-hour urine protein, blood albumin, serum creatinine and eGFR.Conclusions The clinical treatment of elders, male patients, mass proteinuria, those with high pathological staging, renal tubule and interstitial fibrosis is more important.