The Prognostic Analysis Of Patients With Primary Membranous Nephropathy Of Different Pathological Subtypes

Objective: To retrospectively study patients with primary membranous nephropathy with different pathological subtypes under electron microscopy,to understand the curative effect of patients with different pathological subtypes,and to evaluate the prognosis of different pathological subtypes on the prognosis of patients with primary membranous nephropathy.Methods: We retrospectively studied 64 patients with primary membranous nephropathy diagnosed by renal pathology and clinically from July 2015 to June2020,and were followed up for at least 6 months.According to the findings of the electron microscope,they are divided into two subtypes,homogeneous and heterogeneous.Through different treatment methods,observe the curative effect of patients and evaluate the prognosis of remission of different pathological subtypes.Results: Comparison of the initial clinical data of patients in the homogeneous group(n=33)and heterogeneous group(n=31),the number of CD4+ T lymphocytes,anti-phospholipase A2 receptor antibodies,and pathological staging under light microscope The difference was statistically significant(p <0.05),and there was no significant difference in other clinical data between the two groups(p >0.05).The number of CD4+ T lymphocytes in the heterogeneous group was higher than that in the homogeneous group.At the half-year follow-up,the remission rate of the homogeneous group was 54.55%.The remission rate of the heterogeneous group was 29.03%.At the end of the follow-up,the remission rate of the homogeneous group was 81.82%;the remission rate of the heterogeneous group was 58.06%.Regardless of the follow-up for 6 months or until the end of the follow-up,the difference in remission rate between the two groups was statistically significant(p<0.05).The positive rates of anti-phospholipase A2 receptor antibodies in the homogeneous and heterogeneous groups were 54.84% and 87.1%,respectively.There was a significant difference in the comparison of the positive rates of anti-phospholipase A2 receptor antibodies between the two groups(p <0.05).When the initial use of hormone combined with cyclosporine treatment,the remission rate of the homogeneous group was 86.7%,and the remission rate of the heterogeneous group was 50%,p =0.033.Conclusion: The immunity of heterogeneous patients is more abnormally active,the positive rate of anti-PLA2 R antibody is higher,and the curative effect of heterogeneous patients is relatively poor.When using hormone combined with cyclosporine at the same time,the curative effect of homogeneous patients is better.Heterogeneous types can affect the prognosis of primary membranous nephropathy.Homogeneous and heterogeneous types have certain reference significance for clinical treatment guidance of patients with primary membranous nephropathy.