特发性膜性肾病与膜增生性肾炎的比较

目的对比分析特发性膜性肾病(IMN)与原发性膜增生性肾炎(PMPGS)的临床与病理资料,了解其特点及两者的区别。方法对比分析我院近20年来IMN(551例)与PMPGS(105例)的临床病理资料。结果①IMN和PMPGS均为男性多于女性,两组男女比例比较差异无统计学意义(P>0.05);②IMN及PMPGS的平均年龄分别为(47.22±16.32)岁、(39.10±15.47)岁,差异有统计学意义(P<0.01);③IMN的病程中位数为4月,其中50%的病例在(1～11)月,PMPGS病程中位数为6月,其中50%的病例在(3～24)月,两组差异有统计学意义(P<0.01);④IMN及PMPGS均以肾病综合征为主,两组差异无统计学意义;⑤IMN及PMPGS有血尿者分别占33.76%(186/551)及56.19%(59/105),差异有统计学意义(P<0.01);⑥两组血压、尿蛋白定量、血白蛋白浓度、血IgG、IgA浓度比较差异无统计学意义(P>0.05),但血中IgM、C3、C4的浓度及补体(C3)降低的比例比较,差异有统计学意义(P<0.01);⑦两组合并肾功能不全以及血中尿素氮、肌酐的浓度比较,差异有统计学意义(P<0.01);⑧总体疾病危险度比较,两组差异有统计学意义(P<0.01);⑨两组在肾脏免疫病理表现方面,均有较强的免疫球蛋白沉积,但IMN较PMPGN免疫荧光沉积强,两组比较差异有统计学意义(P<0.01)。结论①两种疾病均为男性多于女性;②临床主要表现为肾病综合征;③PMPGS较IMN血尿常见,补体(C3)降低的比例高;④IMN在肾功能损害合并肾功能不全及疾病危险度的评价较PMPGS轻。

Comparison between idiopathic membranous nephropathy and membranoproliferative nephritis

Objective To understand the characteristics of idiopathic membranous nephropathy(IMN) and primary membranoproliferative glomerulonephritis(PMPGS) and their differences based on contrastive analysis of their clinical and pathological information.Methods We made a contrastive analysis of clinical and pathological information of IMN(551 cases) and PMPGS(105 cases) in the past 20 years in our hospital.Results ① Male patients outnumbered female ones in both groups with little difference(P>0.05).② Significant differences were found between IMN and PMPGS in average age,namely,(47.22±16.32) and(39.10±15.47),respectively(P<0.01).③ Large differences between IMN and PMPGS in median course of disease,namely,4 and 6 months,respectively;the course of disease ranged 1-11 months in IMN and 3-24 months in PMPGS in 50% cases,respectively(P<0.01).④ Nephritic syndrome was the major clinical manifestation in both groups with little difference(P>0.05).⑤ Hematuria occurred in 33.76%(186/551) of IMN patients and 56.19%(59/105) of MPGS ones,with significant difference(P<0.01).⑥ The two groups did not differ significantly in blood pressure,quantitative analysis of urinary album,concentration of album,IgG and IgA(P>0.05),but in concentration of IgM,C3 and C4 and the ratio of existing complement reduction(C3)(P<0.01).⑦ Large differences were found in incidence of renal insufficiency as well as the concentration of BUN and Scr between IMN and PMPGS(P<0.01).⑧ As to the overall disease risk degree,there were large differences between the two groups(P<0.01).⑨ Pathological features: Although immunoglobulin deposition was strong in both diseases,it was significantly stronger in IMN than in PMPGS(P<0.01).Conclusion ① Male patients outnumber female ones in both diseases.② Nephritic syndrome is the major clinical manifestation.③ Hematuria is more common in PMPGS than in IMN;the ratio of existing complement reduction(C3) is higher in PMPGS.④ Renal functional lesion is not so serious in IMN as in PMPGS.