86例膜性肾病回顾性分析及对CD4^＋CD^25＋调节性T细胞的初步研究

目的：回顾性总结、分析86例膜性肾病患者的临床表现、实验室检查及肾活检病理的特点及相互联系,认识膜性肾病的发病和流行病学特点。通过对特发性膜性肾病（idiopathic membranous nephropathy,IMN）患者和正常人外周血CD4＋CD2＋5调节性T细胞（Treg细胞）数量的检测,了解Treg在IMN患者外周血的变化规律,探讨其在IMN发病中的作用。方法：2004年3月～2008年12月间病理确诊为膜性肾病患者86例,分析患者一般资料、病理类型和临床特征。选择2007年～2008年IMN患者10例,随机选取与IMN患者年龄相匹配的健康志愿者10例,检测所有对象外周血Treg细胞数量。结果：（1）86例膜性肾病患者,其中IMN68例,占80%,4例患者随访后确诊为恶性肿瘤;继发性膜性肾病18例（其中乙肝病毒相关性肾炎5例,狼疮性肾炎4例,移植肾肾小球肾炎1例）,占20%。（2）IMN免疫荧光以IgG沉积为主,乙肝病毒相关性肾炎C1q沉积较IMN多（P〈0.05）,并均存在HBsAg沉积,与IMN相比狼疮性肾炎C1q沉积明显增多,C4也多于IMN（P〈0.05）。（3）病理分期分布特点：Ⅱ期膜性肾病多见。（4）IMN患者治疗前外周血Treg细胞占CD4＋淋巴细胞的百分比为（7.46±0.94）%,正常对照组为（6.54±1.0）%。结论：（1）根据病因分为IMN及继发性膜性肾病两种,男性发病率大于女性,中老年多发,继发性膜性肾病的年龄及性别分布根据病因的不同而有所不同,临床表现均以肾病综合征表现为主;IMN发病率明显大于继发性膜性肾病。（2）免疫荧光检查：IMN以IgG及C3沉积为主,乙肝病毒相关性肾炎均存在乙肝表面抗原,狼疮性肾炎与乙肝病毒相关性肾炎的C1q沉积较特发性膜性肾病明显增多（P〈0.05）。（3）IMN患者外周血Treg细胞数量较正常人增多。

Retrospective Analysis of 86 Cases with Membranous Nephropathy and Research on Amount of CD4+ CD25+ Regulatory T cells

Objective：To retrospectively analyze clinical manifestations,laboratory examination and pathological features of 86 patients with membranous nephropathy.Amount of CD^＋4CD^＋25 regulatory T cells （Treg） in peripheral blood were detected to explore their roles on idiopathic membranous nephropathy （IMN）.Methods：Eighty-six patients with membranous nephropathy were included from March 2004 to December 2008 in our hospital and patients＇ general data,pathological types and clinical features were analyzed.Amount of Treg was detected by Flow Cytometry.Treg number of 10 patients selected with IMN was compared with age-matched 10 healthy volunteers.Results：（1）68 patients were diagnosed as IMN accounting for 80% and 4 patients as malignant tumor after follow-up;18 cases were secondary membranous nephropathy （including 5 cases caused by hepatitis B virus-associated glomerulonephritis,and 4 cases by lupus nephritis and one case of onset after renal transplantation） accounting for 20%.（2）IgG deposits along capillary walls in IMN and C1q was much more in hepatitis B virus-associated glomerulonephritis than that in IMN （P〈0.05）,Compared with IMN,significantly increased C1q and C4 deposition in lupus nephritis （P〈0.05）.（3）Stage Ⅱ membranous nephropathy was more common.（4）Treg cells accounted for（7.46 ±0.94）% of the percentage of CD＋4 lymphocytes in IMN patients with pre-treatment;while it was（6.54±1.0）% in the normal control group.Conclusion：（1）Membranous nephropathy can be divided into IMN and secondary membranous nephropathy based on the causes.Peak occurrence of IMN is in middle-aged males.Secondary membranous nephropathy shows different clinical manifestations according to age and sex distribution of the different causes.Incidence of this disease in IMN patients is significantly more than that of secondary membranous nephropathy.（2）IgG and C3 deposits mainly in IMN.In addition to IgG and C3 deposition,hepatitis B surface antigen exists in hepatitis B virus associated glomerulonephritis.C1q deposition is much more in Lupus nephritis patients and patients with hepatitis B virus-associated glomerulonephritis than that in IMN patients（P〈0.05）.（3）Treg number of IMN patients increased significantly,compared with that of normal controls.