中文摘要：

目的回顾性分析2013年至2015年本院特发性膜性肾病（IMN）患者的临床流行病学特点，探讨其保守治疗和免疫抑制治疗的效果和影响因素。方法选取2013年1月至2015年12月在本院确诊为IMN的患者183例，收集患者基线临床病理资料，每例患者至少随访12个月。血清白蛋白〈30g／L，24h尿蛋白量〉3．5g定义为肾病综合征。IMN患者分为肾病综合征组和非。肾病综合征组，比较两组患者的基线资料。比较治疗有效和无效患者的基线资料差异，及采用二元Logistic回归分析评估保守治疗或免疫抑制治疗疗效与基线资料的相关性。结果（1）IMN占本院肾活检病例的11．1％，平均年龄57岁，男性占59．6％。（2）与非。肾病综合征IMN患者比较，肾病综合征的IMN患者年龄大，发病至接受肾活检的时间短，总胆固醇、低密度脂蛋白胆固醇、三酰甘油和血清肌酐高，估算的肾小球滤过率低（均P〈0．05）。（3）非肾病综合征IMN患者保守治疗65．7％有效，34．3％无效，无效患者三酰甘油高于有效患者（P=0．019），其余指标差异均无统计学意义。（4）肾病综合征IMN患者免疫抑制治疗81．2％有效，18．8％无效，。肾活检时低血清白蛋白是免疫抑制治疗效果不佳的独立危险因素（OR=1．202，95％C1：1．003～1．440，P=0．046）。（5）肾病综合征IMN患者保守治疗55．5％有效，44．5％无效，肾活检时低血清白蛋白是保守治疗效果不佳的独立危险因素（OR=1．629，95％CI：1．047～2．536，P=0．023）。结论IMN检出率逐年上升，但轻中度患者保守治疗的缓解率仍然不低。对于非肾病综合征患者，高三酰甘油可能是保守治疗效果不佳的预测指标；对于肾病综合征表现者，无论免疫抑制治疗还是保守治疗，低血清白蛋白是其疗效不佳的预测指标。

英文摘要：

Objective To retrospectively analyze the clinical epidemiology features of adult idiopathic membranous nephropathy （IMN） in Zhongshan Hospital, and to investigate their therapeutic effect and its possible influence factors. Methods A total of 183 patients admitted to the Zhongshan Hospital of Fudan University and diagnosed as IMN by renal biopsy from January 2013 to December 2015 were involved. Their baseline information including demographics and pathologic was collected. Patients were followed up for at least 12 months. Serum albumin 〈 30 g/L and 24 h urine protein 〉 3.5 g were defined as nephrotic syndrome （NS）. IMN patients were divided into NS and non-NS groups and compared. Furthermore, the baseline data of remission and no remission patients were compared, and the correlations of their baseline data with conservative and immunosuppressive therapy were assessed by logistic regression analysis. Results （1） IMN accounted for 11.1% of renal biopsy cases in our hospital, with an average age of 57 years and 59.6% male patients. （2） Compared with patients without NS, IMN patients with NS were older, had a shorter time from the onset to receive renal biopsy, lower estimated glomerular filtration rate, and higher total cholesterol, low density lipoprotein cholesterol, triglyceride and serum creatinine （all P 〈 0.05）. （3） The effective rate of conservative treatment in IMN patients without NS was 65.7%, and the ineffective group had higher triglyceride compared with the effective group （P=0.019）. （4） The effective rate of immunosuppressive therapy in IMN patients with NS was 81.2%, and low serum albumin was an independent risk factor for the poor efficacy of immunosuppressive therapy （OR=1.202, 95% CI 1.003- 1.440, P=0.046）. （5） The effective rate of conservative treatment in IMN patients with NS was 55.5%, and low serum albumin was an independent risk factor for the poor efficacy of conservative treatment （OR=1.629, 95%CI 1.047-2.536, P=0.023）. Conclusions The detec