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目的 :前瞻性观察原发性膜增生性肾炎 (MPGN)患者的自然病程 ,了解其远期预后及影响预后的各种因素 方法 :1982年 1月～ 2 0 0 0年 12月间 ,在本院经肾活检确诊并常年定期随访的MPGN 74例 ,Ⅰ型和Ⅲ型MPGN各 37例。以SCr>130 μmol/L作为肾功能损害 ,SCr>80 0 μmol/L确定为终未期肾衰 (ESRF) ,并用Kaplan Meier方法计算患者的肾功能损害发生率及肾脏存活率 结果 :在平均随访 48 6 (13～ 15 2 )月后 ,共有 43例 (5 8 1%)患者发生程度不等的肾功能损害 ,其中ESRF的发生率为 16 2 %。Ⅰ型MPGN有 2 7例出现肾衰 (73 0 %) ,Ⅲ型MPGN患者中 16例发生肾功能损害 (4 3 2 %) ,两者肾功能损害发生率相比差异显著 (P <0 0 5 )。进一步用Kaplan Meier方法计算 ,得出本组MPGN患者 5年和 8年的肾存活率分别为 90 %和 6 4%。按患者的临床症候群将其分为高血压型(HT)、肾病综合征型 (NS)及非肾病综合征型 (non NS)三组进行比较 ,HT组患者病情进展最快 ,而NS组与non NS组患者无明显差别。进一步将患者分为大量蛋白尿 (尿蛋白 >3g/ 2 4h)与非大量蛋白尿 (尿蛋白 <3g/ 2 4h)两组进行分析 ,显示大量蛋白尿者的疾病进展速度快 ,远期预后差。观察同时发现 ,长期激素治疗患者的肾存活率与非激素治疗者相似 ;ACEI治疗组肾
Objective: To prospectively observe the natural history of patients with primary membranoproliferative glomerulonephritis (MPGN), to understand its long-term prognosis and prognostic factors of various ways: January 1982 ~ December 2000, in this 74 cases of MPGN diagnosed by routine renal biopsy and regular follow-up in hospital, 37 cases of type Ⅰ and Ⅲ MPGN. SCr> 130 μmol / L was used as renal impairment, SCr> 80 μmol / L was determined as end-stage renal failure (ESRF), and Kaplan Meier method was used to calculate the incidence of renal dysfunction and renal survival. Results: A total of 43 patients (581%) had varying degrees of renal impairment after 486 (13-15 2) months of follow-up, with an ESRF rate of 16.2%. There were 27 cases of type 1 MPGN with renal failure (73 0%) and 16 cases of type Ⅲ MPGN with renal dysfunction (42 2%), the difference between the two groups was significant (P <0 0 5). Further Kaplan Meier method calculated that this group of 5-year and 8-year renal MPGN survival rates were 90% and 64%. According to the clinical syndrome of the patients, they were divided into three groups: hypertensive (HT), nephrotic syndrome (NS) and non-nephrotic syndrome (NS) Patients in non-NS group had no significant difference. Patients were further divided into two groups: massive proteinuria (urinary protein> 3g / 24 h) and non-massive proteinuria (urinary protein <3 g / 24 h). The results showed that patients with massive proteinuria experienced rapid disease progression and long-term prognosis difference. Observation also found that long-term hormone therapy in patients with renal survival and non-hormone therapy were similar; ACEI treatment group kidney