84例膜性腎病回顧性分析及HCMV、EBV感染的初步觀察
發(fā)布時(shí)間：2018-07-13 15:36
【摘要】：目的： 1.通過分析不典型膜性腎病與特發(fā)性膜性腎病的臨床表現(xiàn)，實(shí)驗(yàn)室檢測(cè)及腎臟病理上的特征，探討其臨床和腎臟病理的特點(diǎn)，為診斷及治療不典型膜性腎病提供依據(jù)。 2.研究EB病毒(EBV)、人巨細(xì)胞病毒(HCMV)在不典型膜性腎病與特發(fā)性膜性腎病患者腎組織中的表達(dá)情況，以探討HCMV，EBV感染與不典型膜性腎病的發(fā)生、發(fā)展的關(guān)系，為不典型膜性腎病發(fā)病機(jī)制的研究和治療提供新的線索。 方法： 回顧性的分析2011年1月~2012年12月就診于山西醫(yī)科大學(xué)第二醫(yī)院腎內(nèi)科經(jīng)腎穿活檢術(shù)后由電鏡確診為膜性腎病的84例患者（其中包括不典型膜性腎病44例，特發(fā)性膜性腎病40例）的完整臨床及病理資料。利用核酸原位雜交技術(shù)檢測(cè)膜性腎病患者腎組織內(nèi)EB病毒(EBV)及人巨細(xì)胞病毒(HCMV)的感染情況。 結(jié)果： 1.不典型膜性腎病患者中男性25例，女性19例，男女比例為1.32:1;發(fā)病年齡17~60歲，平均（31.42士14.5)歲；特發(fā)性膜性腎病患者中男性26例，女性14例，男女比例為1.85:1;發(fā)病年齡42~70歲，，平均（51.08士6.74）歲。兩組性別構(gòu)成比無統(tǒng)計(jì)學(xué)差異(P0.05)，兩組發(fā)病年齡有明顯統(tǒng)計(jì)學(xué)差異（P0.05），不典型膜性腎病發(fā)病年齡主要在30歲左右，而特發(fā)性膜性腎病發(fā)病年齡在40歲以上。 2.44例不典型膜性腎病患者中，34例(77.8%)表現(xiàn)為腎病綜合征，4例(9.1%）患者伴有腎功能不全，32例(72.2%)患者伴有鏡下血尿，12例（27.8%)患者伴有高血壓。40例特發(fā)性膜性腎病患者中，27例(66.7%)表現(xiàn)為腎病綜合征，3例(7.5%）患者伴有腎功能不全，18例(45.8%)患者伴有鏡下血尿，6例（24.3%)患者伴有高血壓。兩者都以腎病綜合征表現(xiàn)為主，且二者腎病綜合征的構(gòu)成比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。伴有腎功能不全及高血壓構(gòu)成比差異也無統(tǒng)計(jì)學(xué)差異，不典型膜性腎病鏡下血尿發(fā)生率高于膜性腎病，有統(tǒng)計(jì)學(xué)差異。 3.特發(fā)性膜性腎病免疫熒光主要以IgG和C3沉積為主，分別為40例(100%)和25例(62.5%），可見IgA沉積者14例(35.0%)、 IgM19例(47.5%)、C1q10例（25.0%）、FRA23例（57.5%）；不典型膜性腎病免疫熒光IgG和C3沉積為主，分別為44例(100%)和33例（75.0%），可見IgA沉積者26例(59.1%)、 IgM35例(79.54%)、C1q35例（79.54%）、FRA27例（61.4%）。兩者免疫熒光比較，均以IgG、C3沉積為主，兩者之間無統(tǒng)計(jì)學(xué)差異；FRA的沉積亦無統(tǒng)計(jì)學(xué)差異；不典型膜性腎病與特發(fā)性膜性腎病相比， Clq、IgA及IgM沉積明顯增多，有統(tǒng)計(jì)學(xué)差異（P0.05）。 4.40例特發(fā)性膜性腎病腎組織中，10例(25%) EB病毒陽(yáng)性，30例(75%）EB病毒陰性；44例不典型膜性腎病腎組織中，檢測(cè)結(jié)果顯示：16例(36%)EB病毒陽(yáng)性，28例(64%）EB病毒陰性，卡方檢驗(yàn)統(tǒng)計(jì)結(jié)果：兩者無統(tǒng)計(jì)學(xué)差異（P0.05） 5.40例特發(fā)性膜腎性腎病組織中，25例(63%) HCMV病毒陽(yáng)性，15例(37%）EB病毒陰性；44例不典型膜性腎病腎組織中，檢測(cè)結(jié)果顯示：40例(90%)HCMV病毒陽(yáng)性，4例(10%）HCMV病毒陰性，卡方檢驗(yàn)統(tǒng)計(jì)結(jié)果：兩者有統(tǒng)計(jì)學(xué)差異（P0.05）。 6.40例特發(fā)性膜腎組織中，12例(30%) HCMV病毒與EBV病毒同時(shí)陽(yáng)性，44例不典型膜腎組織中，10例(20.8%)HCMV病毒與EBV病毒同時(shí)陽(yáng)性，卡方檢驗(yàn)統(tǒng)計(jì)結(jié)果：兩者無統(tǒng)計(jì)學(xué)差異（P0.05）。 結(jié)論： 1.不典型膜性腎病發(fā)病年齡主要在30歲左右，與特發(fā)性膜性腎病在發(fā)病年齡上差異顯著，而性別構(gòu)成比無差別。 2.不典型膜性腎病鏡下血尿較特發(fā)性膜性腎病發(fā)病率高。 3.不典型膜性腎病與特發(fā)性膜性腎病相比，腎臟病理特點(diǎn)有Clq、IgA及IgM沉積明顯增多，有統(tǒng)計(jì)學(xué)差異（P0.05）。不典型膜性腎病的Clq、IgA及IgM沉積率高于特發(fā)性膜性腎病。 4.不典型膜性腎病與特發(fā)性膜性腎病相比，兩者EB病毒陽(yáng)性率比較無統(tǒng)計(jì)學(xué)差異。 5.腎組織中HCMV在膜性腎病中有較高的陽(yáng)性率，且不典型膜性腎病陽(yáng)性率更高，與特發(fā)性膜性腎病相比有統(tǒng)計(jì)學(xué)差異。
[Abstract]:Objective:
1. the clinical and renal pathological features of atypical membranous nephropathy and idiopathic membranous nephropathy were analyzed to provide evidence for the diagnosis and treatment of atypical membranous nephropathy.
2. to investigate the expression of EB virus (EBV) and human cytomegalovirus (HCMV) in the renal tissue of patients with atypical membranous nephropathy and idiopathic membranous nephropathy, in order to explore the relationship between the occurrence and development of HCMV, EBV infection and atypical membranous nephropathy, and provide new clues for the research and treatment of the pathogenesis of atypical membranous nephropathy.
Method:
A retrospective analysis of the complete clinical and pathological materials in 84 patients (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy) diagnosed in the second hospital of Shanxi Medical University, January 2011 ~2012 in the nephrology of Shanxi Medical University after renal biopsy by electron microscopy (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy). The infection of EB virus (EBV) and human cytomegalovirus (HCMV) in renal tissue of patients.
Result:
1. of the patients with atypical membranous nephropathy, there were 25 males and 19 females, with a male and female ratio of 1.32:1; the age of onset was 17~60 years, and the average (31.42 and 14.5) years of age; 26 of males and 14 women in women with idiopathic membranous nephropathy; the male and female ratio was 1.85:1; the age of onset was 42~70 years, and the average (51.08 and 6.74) years old. There was no statistical difference in the sex composition of two groups (P0.05) and two groups. The age of onset was significantly different (P0.05), the age of onset of atypical membranous nephropathy was mainly about 30 years old, and the onset age of idiopathic membranous nephropathy was more than 40 years old.
Of the 2.44 patients with atypical membranous nephropathy, 34 (77.8%) showed nephrotic syndrome, 4 (9.1%) patients with renal insufficiency, 32 (72.2%) accompanied by microscopic hematuria, 12 (27.8%) patients with.40 cases of idiopathic membranous nephropathy, 27 (66.7%) with nephrotic syndrome, 3 (7.5%) patients with renal insufficiency, 18 Cases (45.8%) were accompanied by microscopic hematuria, and 6 (24.3%) patients were accompanied by hypertension. Both were mainly nephrotic syndrome, and the proportion of the two nephrotic syndrome was not statistically significant (P0.05). There was no statistical difference in the difference of renal function and hypertension, and the incidence of hematuria in the atypical membranous nephropathy was higher than that of the membrane. There were statistical differences in sexual kidney disease.
3. the main immunofluorescence of idiopathic membranous nephropathy was mainly IgG and C3 deposition, 40 cases (100%) and 25 cases (62.5%), 14 cases (35%), IgM19 cases (47.5%), C1q10 cases (25%), and FRA23 cases (57.5%). The immunofluorescent IgG and C3 deposition of atypical membranous nephropathy were mainly in 44 (100%) and 33 cases respectively, and IgA depositing cases were seen respectively. .1%), IgM35 cases (79.54%), C1q35 cases (79.54%) and FRA27 cases (61.4%). The immunofluorescence was compared with IgG and C3 deposition, and there was no statistical difference between the two. The deposition of FRA was not statistically different. Compared with the idiopathic membranous nephropathy, the deposition of Clq, IgA and IgM was significantly increased, and there were statistical differences (P0.05).
In 4.40 cases of idiopathic membranous nephropathy, 10 cases (25%) EB virus positive, 30 (75%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 16 cases (36%) EB virus positive, 28 cases (64%) EB virus negative, chi square test statistical results: there was no statistical difference between the two (P0.05)
In 5.40 cases of idiopathic nephrotic nephropathy, 25 cases (63%) HCMV virus positive and 15 (37%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 40 cases (90%) HCMV virus positive, 4 cases (10%) HCMV virus negative, chi square test statistical results: the statistical difference between the two (P0.05).
In 6.40 cases of idiopathic membranous renal tissue, 12 cases (30%) HCMV virus and EBV virus were simultaneously positive, 44 cases of atypical membrane kidney tissue, 10 cases (20.8%) HCMV virus and EBV virus simultaneously positive, chi square test statistical results: there was no statistical difference (P0.05).
Conclusion:
1. the age of onset of atypical membranous nephropathy is mainly around 30 years old. There is a significant difference in age at onset between idiopathic membranous nephropathy and idiopathic membranous nephropathy.
2. the incidence of hematuria in patients with atypical membranous nephropathy is higher than that in idiopathic membranous nephropathy.
3. compared with idiopathic membranous nephropathy, 3. atypical membranous nephropathy was characterized by renal pathological features, IgA and IgM deposits were significantly increased (P0.05). The Clq, IgA and IgM deposition rates of atypical membranous nephropathy were higher than that of idiopathic membranous nephropathy.
4. compared with idiopathic membranous nephropathy, there was no significant difference in the positive rate of EB virus between atypical membranous nephropathy and idiopathic membranous nephropathy.
5. in renal tissue, HCMV has a high positive rate in membranous nephropathy, and the positive rate of atypical membranous nephropathy is higher than that of idiopathic membranous nephropathy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
本文編號(hào)：2119906
[Abstract]:Objective:
1. the clinical and renal pathological features of atypical membranous nephropathy and idiopathic membranous nephropathy were analyzed to provide evidence for the diagnosis and treatment of atypical membranous nephropathy.
2. to investigate the expression of EB virus (EBV) and human cytomegalovirus (HCMV) in the renal tissue of patients with atypical membranous nephropathy and idiopathic membranous nephropathy, in order to explore the relationship between the occurrence and development of HCMV, EBV infection and atypical membranous nephropathy, and provide new clues for the research and treatment of the pathogenesis of atypical membranous nephropathy.
Method:
A retrospective analysis of the complete clinical and pathological materials in 84 patients (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy) diagnosed in the second hospital of Shanxi Medical University, January 2011 ~2012 in the nephrology of Shanxi Medical University after renal biopsy by electron microscopy (including 44 cases of atypical membranous nephropathy and 40 cases of idiopathic membranous nephropathy). The infection of EB virus (EBV) and human cytomegalovirus (HCMV) in renal tissue of patients.
Result:
1. of the patients with atypical membranous nephropathy, there were 25 males and 19 females, with a male and female ratio of 1.32:1; the age of onset was 17~60 years, and the average (31.42 and 14.5) years of age; 26 of males and 14 women in women with idiopathic membranous nephropathy; the male and female ratio was 1.85:1; the age of onset was 42~70 years, and the average (51.08 and 6.74) years old. There was no statistical difference in the sex composition of two groups (P0.05) and two groups. The age of onset was significantly different (P0.05), the age of onset of atypical membranous nephropathy was mainly about 30 years old, and the onset age of idiopathic membranous nephropathy was more than 40 years old.
Of the 2.44 patients with atypical membranous nephropathy, 34 (77.8%) showed nephrotic syndrome, 4 (9.1%) patients with renal insufficiency, 32 (72.2%) accompanied by microscopic hematuria, 12 (27.8%) patients with.40 cases of idiopathic membranous nephropathy, 27 (66.7%) with nephrotic syndrome, 3 (7.5%) patients with renal insufficiency, 18 Cases (45.8%) were accompanied by microscopic hematuria, and 6 (24.3%) patients were accompanied by hypertension. Both were mainly nephrotic syndrome, and the proportion of the two nephrotic syndrome was not statistically significant (P0.05). There was no statistical difference in the difference of renal function and hypertension, and the incidence of hematuria in the atypical membranous nephropathy was higher than that of the membrane. There were statistical differences in sexual kidney disease.
3. the main immunofluorescence of idiopathic membranous nephropathy was mainly IgG and C3 deposition, 40 cases (100%) and 25 cases (62.5%), 14 cases (35%), IgM19 cases (47.5%), C1q10 cases (25%), and FRA23 cases (57.5%). The immunofluorescent IgG and C3 deposition of atypical membranous nephropathy were mainly in 44 (100%) and 33 cases respectively, and IgA depositing cases were seen respectively. .1%), IgM35 cases (79.54%), C1q35 cases (79.54%) and FRA27 cases (61.4%). The immunofluorescence was compared with IgG and C3 deposition, and there was no statistical difference between the two. The deposition of FRA was not statistically different. Compared with the idiopathic membranous nephropathy, the deposition of Clq, IgA and IgM was significantly increased, and there were statistical differences (P0.05).
In 4.40 cases of idiopathic membranous nephropathy, 10 cases (25%) EB virus positive, 30 (75%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 16 cases (36%) EB virus positive, 28 cases (64%) EB virus negative, chi square test statistical results: there was no statistical difference between the two (P0.05)
In 5.40 cases of idiopathic nephrotic nephropathy, 25 cases (63%) HCMV virus positive and 15 (37%) EB virus negative, 44 cases of atypical membranous nephropathy, the results showed: 40 cases (90%) HCMV virus positive, 4 cases (10%) HCMV virus negative, chi square test statistical results: the statistical difference between the two (P0.05).
In 6.40 cases of idiopathic membranous renal tissue, 12 cases (30%) HCMV virus and EBV virus were simultaneously positive, 44 cases of atypical membrane kidney tissue, 10 cases (20.8%) HCMV virus and EBV virus simultaneously positive, chi square test statistical results: there was no statistical difference (P0.05).
Conclusion:
1. the age of onset of atypical membranous nephropathy is mainly around 30 years old. There is a significant difference in age at onset between idiopathic membranous nephropathy and idiopathic membranous nephropathy.
2. the incidence of hematuria in patients with atypical membranous nephropathy is higher than that in idiopathic membranous nephropathy.
3. compared with idiopathic membranous nephropathy, 3. atypical membranous nephropathy was characterized by renal pathological features, IgA and IgM deposits were significantly increased (P0.05). The Clq, IgA and IgM deposition rates of atypical membranous nephropathy were higher than that of idiopathic membranous nephropathy.
4. compared with idiopathic membranous nephropathy, there was no significant difference in the positive rate of EB virus between atypical membranous nephropathy and idiopathic membranous nephropathy.
5. in renal tissue, HCMV has a high positive rate in membranous nephropathy, and the positive rate of atypical membranous nephropathy is higher than that of idiopathic membranous nephropathy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
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本文編號(hào)：2119906
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