老年肾病综合征肾活检病理类型及血清抗M型磷脂酶A2受体IgG水平的研究

目的探讨老年肾病综合征肾活检病理类型及血清M型磷脂酶A2受体(PLA2R)IgG水平,为老年肾病综合征肾脏病理类型的非肾活检诊断提供依据。方法回顾分析2009年1月至2019年6月在中日友好医院肾内科诊断为肾病综合征,并住院期进行肾穿刺活检的老年患者临床数据和肾活检资料。结果共纳入研究对象250例,年龄平均(65.85±4.68)岁,其中男152例,女98例。(1)常见肾活检病理类型:膜性肾病154例(61.6%),微小病变性肾小球病31例(12.4%),局灶节段性肾小球硬化症20例(8.0%),IgA肾病11例(4.4%);继发性肾小球疾病中,糖尿病肾病11例(4.4%),乙型肝炎病毒相关性膜性肾病5例(2.0%),淀粉样变性肾损害5例(2.0%)。(2)对比前后5年间肾活检病理谱变化,膜性肾病(由61.11%增至62.36%)、微小病变性肾小球病(由9.72%增至13.48%)、糖尿病肾病(由4.17%增至4.49%)所占比例略有增加,IgA肾病(由11.11%降至1.69%),局灶节段性肾小球硬化症(由11.11%降至7.30%)所占比例显著下降。近5年来,膜性肾病和肾小球微小病变病两者所占比例达到了75.9%。(3)86例原发膜性肾病检测了血清PLA2R抗体水平,其中44例(51.2%)阳性,肾小球微小病变病和局灶节段性肾小球硬化症患者血清PLA2R抗体均阴性。结论老年肾病综合征中以膜性肾病最常见,其次是肾小球微小病变病,且所占比例有增多趋势。血清PLA2R抗体检测对老年肾病综合征中原发性膜性肾病诊断具有参考意义。

Study on the pathological types of renal biopsy and the serum levels of M-type phospholipase A2 receptor-IgG in elderly patients with nephrotic syndrome

Objective To explore the pathological types of renal biopsy and serum levels of M-type phospholipase A2 receptor(PLA2 R)-IgG in elderly patients with nephrotic syndrome, in order to provide evidence for non-invasive diagnosis of the pathological types of nephrotic syndrome in elderly patients. Methods We retrospectively analyzed the clinical data of elderly patients diagnosed with nephrotic syndrome in the Department of Nephrology of China-Japan Friendship Hospital from January 2009 to June 2019. They also received renal biopsy during hospitalization. Results A total of 250 subjects were enrolled, with an average age of 65.85±4.68 years, including 152 males and 98 females.(1) Pathological types of primary glomerulonephritis: membranous nephropathy(MN)(154 cases, 61.6%), minimal change disease(MCD)(31 cases,12.4%), focal segmental glomerulosclerosis(FSGS)(20 cases, 8.0%), IgA nephropathy(IgAN)(11 cases, 4.4%);in secondary glomerulonephritis: diabetic nephropathy(DN)(11 cases, 4.4%), hepatitis B virus-associated membranous nephropathy(HBV-MN)(5 cases, 2.0%) and amyloidosis(5 cases, 2.0%).(2) Comparing the spectrum of renal biopsy in the first 5 years with the second 5 years : the proportion of MN(from 61.11% to 62.36%), MCD(from 9.72% to 13.48%), DN(from 4.17% to4.49%) were tended to increase, IgAN(from 11.11%to 1.69%) and FSGS(from 11.11% to 7.30%) were tended to decrease. The most common pathological types in this study were MN, MCD. The proportion of the two has reached 75.9% in the past 5 years.(3) In this study, 86 patients with primary membranous nephropathy were tested for serum PLA2 R antibody levels, of which 44(51.2%) patients were positive. The serum PLA2 R antibody was negative in patients with MCD and FSGS. Conclusion MN is the most common pathological type of elderly patients with nephrotic syndrome, followed by MCD, and the proportion is inclined to increase. Serum PLA2 R antibody detection is a valuable reference in the diagnosis of primary MN in elderly patients with nephrotic syndrome.