不同性别的原发性膜性肾病的临床及病理分析

目的了解不同性别的原发性膜性肾病的临床、病理特点及其有无区别。方法回顾分析我院482例原发性膜性肾病的临床及病理资料。结果①发病年龄:男(46.89±16.73)岁,女(48.39±15.45)岁,两组差异无统计学意义(P>0.05);②临床表现:在病程、血尿、高血压的发生率方面两组无差异(P>0.05),而浮肿的发生率男性81.43%,女性88.57%,女性高于男性(P<0.05);临床主要表现为肾病综合征,男、女性分别为82.41%(253/307)、82.29%(144/175),两组无差异(P>0.05);③实验室检查:尿蛋白定量男性(4.79±2.88)g/(1.73m2.d),女性(4.15±1.85)g/(1.73m2.d),血浆白蛋白男性(25.86±7.87)g/L,女性(27.05±6.57)g/L,血IgG水平男性(7.11±3.66)mmol/L,女性(8.05±3.33)mmol/L,分别行两组间比较均有差异(P<0.05);尿蛋白定量与血浆白蛋白、血IgG呈负相关,与胆固醇呈正相关(P<0.05),男女间结果一致;尿素氮男性(6.67±4.21)mmol/L,女性(5.43±2.96)mmol/L,肌酐男性(102.82±110.3)μmol/L,女性(83.06±89.61)μmol/L,两组均有差异(P<0.05),但经体表面积校正后两组肌酐清除率比较无差异(P>0.05);④病理方面:免疫荧光检查除无肾小球的外,均为免疫复合物性肾小球肾炎,以IgG沉积为主,男性占98.96%,女性99.40%,病理类型以Ⅰ期膜性肾病最常见,男女性分别为62.54%、61.14%,两组间无差异;⑤危险度评价,男性较女性高。结论①原发性膜性肾病好发于中老年,男性多于女性;②临床主要表现为肾病综合征;③男性的尿蛋白量大于女性,而血浆白蛋白、血IgG低于女性,胆固醇高于女性;④病理以Ⅰ期膜性肾病常见。

Clinical and pathological analysis of idiopathic membranous nephropathy in different genders

Objective To explore the clinical and pathological features of idiopathic membranous nephropathy in males and females.Methods A retrospective analysis was made of the clinical and pathological information of 482 cases of idiopathic membranous nephropathy in our hospital.Results ① The onset age:(46.89±16.73) years in males and(48.39±15.45) years in females,without any difference(P>0.05).② Clinical manifestations: Men and women hardly differed in the course of disease and the incidence of hypertension and haematuria(P>0.05),while the occurrence of dropsy was significantly higher in females(88.57%) than in males(81.43%)(P<0.05).The major clinical manifestation was nephrotic syndrome,82.41%(253/307) in males and 82.29%(144/175) in females,respectively,with no significant difference(P>0.05).③ Laboratory observations: Males and females differed significantly in the quantitative analysis of urinary albumin [(4.79±2.88)g/(1.73 m2·d) in males and(4.15±1.85)g/(1.73 m2·d) in females],plasma albumin [(25.86±7.87)g/L in males and(27.05±6.57)g/L in females],and blood IgG [(7.11±3.66)mmol/L in males and(8.05±3.33)mmol/L in females](all P<0.05).Urinary albumin was negatively correlated with plasma albumin and blood IgG,but positively correlated with cholesterol(P<0.05),which were the same for males and females.Large differences were found between males and females in BUN [(6.67±4.21)mmol/L in males and(5.43±2.96)mmol/L in females] and creatinine [(102.82±110.3)μmol/L in males and(83.06±89.61)μmol/L in females](both P<0.05),but with no difference in creatinine clearance rate after adjusting the surface area(P>0.05).④ Pathological features: Immunofluorescence assay detected immune complex nephritis with glomerulus dominated by IgG deposition(98.96% in males and 99.40% in females).Idiopathic membranous nephropathy was most frequently seen as pathological stage I with little differences in the occurrence rate for males(62.54%) and females(61.14%).⑤ Estimation of the risk degree: It was higher in males than in females. Conclusion① Idiopathic membranous nephropathy frequently occurs at the middle and old age;men are more likely to be affected than women.② Nephrotic syndrome is the major clinical manifestation.③ Males have higher urinary albumin and cholesterol levels but lower plasma albumin and blood IgG than females.④ Idiopathic membranous nephropathy is most frequently seen as pathological stage I.