| backgrounds and objections:Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults, Pathologically, MN is characterized by thickening of the glomerular capillary wall and subepithelial immune deposits.MN can be subdivided into idiopathic and secondary classifications. The etiology is unknown in idiopathic membranous nephropathy, while in some patients, MN may be secondary to infection, to other diseases, or to exposure to drugs and toxic substances. Etiology and pathogenesis of idiopathic membranous nephropathy are not yet clear.Clinical and histopathological features can affect the outcome and prognosis of membranous nephropathy.There have long been controversies and doubts about therapy of MN.Many researches consider that high-risk patients with ESRD tend to the treatment as soon as possible.Judging the prognosis of MN by clinical and histopathological features is important to the therapy of MN。This paper aimed at analyse the distribution,clinical manifestation,characteristics of laboratory examination,different pathological types and relationship among them in 85 cases with MN by retrospectively reviewed.That can help understand the nature of MN,and provide the basis for the treatment. in recent years , CD4 + CD25 + Tr cells can prevent pathological immune response to injury,that aroused widespread interest, CD4+ CD25+ Tr cells maintained the body's own stability through a proactive approach , they could inhibit the immune response, also,they played some role in the immune pathology,immune tolerance and maintenance of immune balance. The purpose of this research is investigate whether Tr cells play some role in the Pathogenesis of IMN by detecting the number of CD4 + CD25 +Tr cells in peripheral blood of membranous nephropathy patients and normal human.Providing new idears for the therapy of MN.Research Methods:85 MN patients were included in this study, who choosed in the second clinical hospital of Jilin University From March 2004 to December 2008 .All patients had renal biopsy.68 cases were IMN,9 cases were Hepatitis B virus associated glomerulonephritis and 8 cases were LN. 4 patients with malignant tumor were found among patients of IMN.Clinical data collected from the history records, including age at the time of biopsy,gender,the fist signs and symptoms. Laboratory test results are derived from the test of patients admitted to hospital after , including the 24-hour urine protein,blood biochemical, serological examination. Retrospective analysis of general information,the distribution of pathological types and clinical features of pathological types.We selected 10 IMN patients in our hospital from 2007 to 2008 as test group, and randomly selected 10 age-matched healthy volunteers as the control group ,All the objects had no acute or chronic infections and other autoimmune diseases. IMN patients did not receive any treatment. The number of CD4+CD25+Tr cells in peripheral blood of test group and the control group were detected by flow cytometry.Statistical analysis:The qualitative data of clinical and laboratory examination on present as the number of case, and the quantitative data present as mean±standard deviation. The count data used analysis of variance and chisquaretest, and measurement data by t-test, P<0.05 defined as a statistically significant difference.Results:(1)85 MN patients were included in this study,68 cases were IMN (80%) , 17 cases were secondary Membranous nephropathy(20%),9 cases were Hepatitis B virus associated glomerulonephritis and 8 cases were LN. 4 patients with malignant tumor were found among patients with IMN.Of patients with IMN, 45 (66.2%) were men and 23 (33.8%) were women. Mean age was 43.31±17.80years (range, 15 to 72 years). Of patients with Hepatitis B virus associated glomerulonephritisand, 4(44.4%) were men and 5 (55.6%) were women. Mean age was 31.60±10.29years (range, 19 to 41years). Of patients with LN, 2(25%) were men and 6(75%) were women. Mean age was 34.75±12.years (range, 20 to 48years).(2)There is no statistically significant differences in clinical manifestation between IMN and secondary Membranous nephropathy (P>0.05).(3)Immunofluorescence test of MN:IgG was common found in IMN,C1q was more common found in Hepatitis B virus associated glomerulonephriti- sand than in IMN(P<0.05),HBsAg can be found specifically in Hepatitis B virus associated glomerulonephritisand,C1q and C4 are more common found in LN than in IMN(P<0.05).(4)Distribution of pathological stage:II stage was the most common type,followed by I stage and II stage ,IV stage was uncommon.(5)There is no statistically significant difference in clinical manifestation and Laboratory results between different pathological types (P>0.05).(6)The percentage of CD4 + CD25 + Tr cells in peripheral blood of IMN patients:7.46±0.94%.The percentage of CD4 + CD25 + Tr cells in peripheral blood of nomal human:6.54±1.0%. the number of CD4+CD25+Tr cells in peripheral blood of test group is more than in peripheral blood of the control group(P<0.05).Conclusions:(1)MN can be subdivided into idiopathic and secondary classifications.The incidence of IMN was greater than secondary Membranous nephropathy,For IMN, the sex ratio of male and female cases was 1.96:1,male incidence rate was greater than women,,Cases were mainly concentrated in people at age of 40-60. Proteinuria and edema were the most common symptoms,Nephrotic syndrome was the main manifestation。Age and gender distribution of secondary membranous nephropathy were different, because of different etiology,Nephrotic syndrome was also the main manifestation in secondary membranous nephropathy.(2)Immunofluorescence examination:IgG was common founde in IMN,C1q was more common found in secondary membranous nephropathy than in IMN(P<0.05),HBsAg could be found specifically in Hepatitis B virus associated glomerulonephritisand.(3)II stage was the most common type,followed by I stage and II stage ,IV stage was uncommon。There werw no statistically significant differences in clinical manifestation and Laboratory results between different pathological types (P>0.05).(4)the number of CD4+CD25+Tr cells in peripheral blood of test group is more than in peripheral blood of the control group(P<0.05). |
