本文選題：腎病綜合征 + 膜性腎病��； 參考：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：目的通過分析65例經(jīng)腎活檢診斷為膜性腎病患者的臨床及病理資料,探討膜性腎病的臨床及病理特點,為臨床正確診斷、治療、評估預后等提供更多理論依據(jù);同時增進對不典型膜性腎病的認識。方法收集寧夏回族自治區(qū)人民醫(yī)院腎內科2011年11月至2016年12月行腎穿刺活檢診斷為膜性腎病的65例患者的病例資料:包括一般情況,實驗室檢查:血常規(guī)、尿常規(guī)、24小時尿蛋白、尿紅細胞形態(tài)、肝腎功能、血脂、免疫指標、肝炎全套,腎臟彩超,病理資料:膜性腎病病理分型及分期、腎小球硬化情況、新月體個數(shù)、系膜增生、腎小管萎縮、腎間質纖維化、腎動脈增厚情況,免疫熒光沉積部位、種類及強弱等。并根據(jù)不同性別、年齡、24小時蛋白尿、eGFR、血尿及病理類型進行分組,統(tǒng)計分析比較不同組間患者的臨床及病理資料特點。同時用免疫組化方法檢測腎組織M型磷脂酶A2受體(PLA2R)在膜性腎病患者的表達情況。結果1、一般資料及臨床資料分析:65例膜性腎病患者的年齡為(50.5±14.5)歲,以中老年多見,男41例,女24例,男女性別比1.71:1。以浮腫就診者最為多見,為49例(75.4%),臨床表現(xiàn)主要為腎病綜合征的50例(76.9%),伴血尿者54例(83.1%),其中1例表現(xiàn)為肉眼血尿,伴高血壓者19例(29.2%),高脂血癥者60例(92.3%),腎功能下降者25例(38.5%)。2.不同分組間臨床及病理資料分析:(1)不同性別組比較:兩組間在臨床表現(xiàn)上無明顯差異,但在不同病理類型中存在差異,男性患者多以特發(fā)性膜性腎病為主(68.3%VS 37.5%),女性患者多以不典型膜性腎病為主(50%VS 19.5%)(P0.05)。(2)不同年齡組間比較:各年齡組均以男性發(fā)病多見,老年組較青年組具有較低的eGFR和更高的高血壓發(fā)生率(P0.01)。(3)不同程度蛋白尿組間比較:隨著24小時尿蛋白的增加,血漿白蛋白水平較低,肌酐水平較高;大量蛋白尿組患者膽固醇水平較高、eGFR較低(P0.05)。(4)不同eGFR組間比較:與腎功能正常組相比,腎功能下降組患者具有年齡較大、基礎血肌酐水平較高的特點,差異有統(tǒng)計學意義(P0.01)。(5)有無血尿組間比較:有血尿者比無血尿組發(fā)病年齡低,差異有統(tǒng)計學意義(P0.05)。3、病理資料分析:特發(fā)膜性腎病37例(56.9%),其中I期、II期、I-II期膜性腎病分別為22例(59.5%)、11例(29.7%)、4例(10.8%),無III期及IV期患者。不典型膜性腎病20例(30.8%),繼發(fā)膜性腎病8例(12.3%),以乙肝相關性膜性腎病最為多見,6例(75.0%),2例狼瘡性腎炎(25.0%)。免疫熒光以IgG沉積為主,65例(100%)。不典型膜性腎病及繼發(fā)性膜性腎病較特發(fā)性膜性腎病有更高的系膜增生率及IgA、C1q沉積率(P0.01)。特發(fā)性膜性腎病男性發(fā)病率高于不典型膜性腎病(P0.05),繼發(fā)性膜性腎病患者較特發(fā)性膜性腎病患者有較低的白蛋白水平(P0.05)。4、PLA2R在膜性腎病患者腎組織中的表達情況:PLA2R在IMN、AMN、SMN中的陽性率分別為90.6%、93.3%、42.9%,經(jīng)組間比較顯示IMN及AMN較SMN有較高的PLA2R陽性率,差異有統(tǒng)計學意義(P=0.014),SMN中HBV-MN陽性率較高,為60.0%。結論膜性腎病好發(fā)于中老年男性患者,臨床表現(xiàn)以腎病綜合征多見。高齡及大量蛋白尿為膜性腎病腎功能進展的危險因素。不典型膜性腎病的發(fā)病率較高,而且PLA2R在不典型膜性腎病中陽性率和在特發(fā)性膜性腎病一樣高。
[Abstract]:Objective to analyze the clinical and pathological data of 65 patients with membranous nephropathy diagnosed by renal biopsy, to explore the clinical and pathological features of membranous nephropathy, and to provide more theoretical basis for the correct diagnosis, treatment and evaluation of prognosis, and to improve the understanding of atypical membranous nephropathy. Methods collect the nephrology department of the people's Hospital of the Ningxia Hui Autonomous Region. From November 2011 to December 2016, 65 cases of membranous nephropathy were diagnosed by renal biopsy: general condition, laboratory examination: blood routine, urine routine, 24 hour urine protein, urine red cell morphology, liver and kidney function, blood lipid, immune index, hepatitis whole set, kidney color Doppler, pathological data: membranous nephrosis pathological classification and staging, kidney The case of sclerotherapy, the number of crescent crescent, mesangial hyperplasia, renal tubule atrophy, renal interstitial fibrosis, renal artery thickening, immunofluorescence site, type and strength, etc. were divided according to different sex, age, 24 hours proteinuria, eGFR, hematuria and pathological type, and compared the clinical and pathological data of patients with different groups. At the same time, the expression of M type phospholipase A2 receptor (PLA2R) in renal tissue was detected by immunohistochemical method. Results 1, general data and clinical data analysis: 65 cases of membranous nephropathy were (50.5 + 14.5) years old, middle-aged and old, male 41, female 24, and sex ratio of male and female to swollen patients was the most common, 49, 49. 49 Cases (75.4%), the clinical manifestations were mainly nephrotic syndrome in 50 cases (76.9%) and 54 cases of hematuria (83.1%), including 1 cases with naked hematuria, 19 patients with hypertension (29.2%), 60 patients with hyperlipidemia (92.3%), 25 (38.5%) renal function decline (38.5%).2. different groups of clinical and pathological data analysis: (1) different sex groups in clinical tables between different groups There was no significant difference at present, but in different pathological types, male patients were mostly with idiopathic membranous nephropathy (68.3%VS 37.5%), female patients were mostly with atypical membranous nephropathy (50%VS 19.5%) (P0.05). (2) the comparison between different age groups: all age groups are more common in males and lower eGFR in the older group than in the young group. Higher incidence of hypertension (P0.01). (3) compared with different levels of proteinuria, plasma albumin level was lower and creatinine level was higher with the increase of 24 hours urine protein; the levels of cholesterol in the large albuminuria group were higher, and the eGFR was lower (P0.05). (4) the comparison of different eGFR groups: compared with the normal renal function group, the patients with the renal function decline group have a higher level of renal function. There was a higher age and higher level of basic blood creatinine (P0.01). (5) compared with or without hematuria, there was a lower incidence of hematuria than that in the non hematuria group, the difference was statistically significant (P0.05).3, pathological data analysis: 37 cases of idiopathic nephrotic disease (56.9%), of which 22 cases (59.5%) were I, II, and I-II membranous nephropathy, 1 1 (29.7%), 4 (10.8%), no III and IV, 20 cases of atypical membranous nephropathy (30.8%), 8 cases of membranous nephropathy (12.3%), the most common of hepatitis B related membranous nephropathy, 6 (75%), 2 lupus nephritis (25%). Immunofluorescence was mainly IgG deposition, 65 cases (100%). Atypical membranous nephropathy and secondary membranous nephropathy were more idiopathic membranous nephropathy. The rate of mesangial hyperplasia and IgA, C1q deposition rate (P0.01). The incidence of idiopathic membranous nephropathy in men is higher than that of atypical membranous nephropathy (P0.05). Secondary membranous nephropathy has a lower albumin level (P0.05).4 than that of idiopathic membranous nephropathy (P0.05), and the expression of PLA2R in the renal tissue of patients with membranous nephropathy: PLA2R in IMN, AMN, S. The positive rates in MN were 90.6%, 93.3% and 42.9% respectively. Compared with SMN, the positive rate of IMN and AMN was higher than that of SMN. The difference was statistically significant (P=0.014), the positive rate of HBV-MN in SMN was higher. The risk factors for the progression of renal renal function. The incidence of atypical membranous nephropathy is higher, and the positive rate of PLA2R in atypical membranous nephropathy is as high as that of idiopathic membranous nephropathy.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692

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