| Objective:The clinical and pathological data of 335 cases of patients with idiopathic membranous nephropathy(IMN)and 101 cases of patients with atypical membranous nephropathy(AMN)were retrospectively analyzed.The differences in clinical and pathological features between the patients of two groups were compared,and the laboratory parameters for 3 months and 6 months follow-up on 105 cases of IMN and20 cases of AMN patients were compared,to provide a clinical basis for the differential diagnosis and prognosis of AMN and IMN.Methods:436 patients diagnosed as Membranous Nephropathy(MN)by nephropathy biopsy from December 2015 to October 2018 in nephrology department of our hospital were selected as subjects,with dividing into two groups(335 cases in IMN group and 101 cases in AMN group),to conduct the retrospective analysis on the clinical and pathological data to be included,so as to compare the clinical and pathological features of the patients in two groups.Among them,the follow-up data in125 cases of patients(105 cases in IMN group,20 cases in AMN group)were complete,and the relevant laboratory indicators for 3 months and 6 months follow-upof them were compared.SPSS21.0 software was used for statistical analysis in this study.Results:1.Among 436 patients with MN,335 cases(76.8%)were in IMN group and 101cases(23.2%)were in AMN group.2.In 335 cases of IMN patients,the ratio of male to female was 1.60:1,the average age was 51.4±12.2 years old,the ratio of urban to rural areas was 0.77:1.In101 cases of AMN patients,the ratio of male to female was 0.77:1,the average age was 53.6±12.5 years old,the ratio of urban to rural areas was 1.15:1.The age in AMN patients was older than that of IMN patients(p<0.05).3.In 335 cases of IMN patients,the clinical manifestations of nephrotic syndrome were 273 cases(81.5%),microscopic hematuria were 267 cases(79.7%),hypertension were 146 cases(43.6%).In 101 cases of AMN patients,the clinical manifestations of nephrotic syndrome were 90 cases(89.1%),microscopic hematuria were 82 cases(81.2%),hypertension were 49 cases(48.5%).There was no significant difference between the groups.4.The values of U?1MG,U?2MG and NAG in AMN patients were higher than those in IMN patients(p<0.05),while Alb in AMN patients was lower than that in IMN patients(p<0.05).5.Light microscopy showed that the positive rates of nail process formation,Arterial hyalinization and bare basement membrane formation in AMN patients werehigher than those in IMN patients(p<0.05).Immunofluorescence showed that the positive rate of lgA,IgM,complement C4,Clq,IgG1,IgG2 and IgG3 subtypes deposition in AMN patients were higher than that in IMN patients(p<0.05),while the positive rate of IgG4 deposition in AMN patients was lower than those in IMN patients(p<0.01).Electron microscopy showed that the positive rate of electron dense deposits in the mesangium and subendothelium of AMN patients was higher than that of IMN patients(p<0.01).The positive rate of endothelial cell,mesangial cell proliferation and mesangial matrix increase in AMN patients was higher than that in IMN patients(p<0.01).6.125 patients(105 cases in IMN group and 20 cases in AMN group)have complete follow-up data.The treatment regimen was mainly hormone combined with cyclophosphamide,followed by hormone combined with cyclosporine.The total remission rate was 52.4% and 81% in IMN group at 3 months and 6 months follow up respectively.The total remission rate was 65% and 80% in AMN group at 3 months and 6 months follow up respectively.There was no significant difference between the groups.Conclusion:1.There was no significant difference in clinical manifestations between the patients of IMN and AMN groups,with little significance for the differential diagnosis of the disease.2.Renal tubular injury in AMN patients may more severe than IMN patients.3.Immunofluorescence showed that the positive rates of IgG1,IgG2 and IgG3 subtypes in AMN patients were higher than those in IMN patients,and the positive rates of IgG4 were lower than that in IMN patients,The distribution of IgG subtypes in renal tissue is significance for differential diagnosis between AMN and IMN.4.There was no significant difference in total remission rate between IMN and AMN groups after 3 months and 6 months treatment. |
PDF Full Text Request