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目的:探讨IgG排泄分数(FE IgG)对特发性膜性肾病(IMN)患者药物反应性及病情缓解的预测意义。方法:回顾性分析2014年4月至2017年8月本院经临床及病理资料确诊并定期随访的IMN患者82例，利用ROC曲线确定预测临床缓解时间的FE IgG界值，对比基线不同FE IgG水平临床缓解时间的差别，分析不同FE IgG水平对免疫抑制治疗(他克莫司或环磷酰胺)及支持治疗的药物反应性的影响。结果:绘制eGFR、24 h尿蛋白定量及FE IgG预测临床缓解时间的ROC曲线，曲线下面积(AUC)分别为0.509、0.701、0.948；确定FE IgG界值为0.029，所有患者分为高水平组(FE IgG>0.029)、低水平组(FE IgG0.05)，两组间FE IgG、24 h尿蛋白定量、血清白蛋白差异有统计学意义(n P<0.05)；两组临床缓解时间分别为(18.75±6.81)个月、(8.46±3.74)个月，差异有统计学意义(n P<0.001)。FE IgG低水平免疫抑制治疗组与FE IgG低水平支持治疗组缓解时间比较差异无统计学意义(n P＝0.265)，二者均低于FE IgG高水平免疫抑制治疗组(n P<0.001)；FE IgG高水平组中他克莫司组较环磷酰胺组缓解时间缩短，但差异无统计学意义(n P＝0.131)；FE IgG高、低水平组间他克莫司治疗缓解时间比较差异有统计学意义(n t＝6.734，n P<0.001)；电镜下，FE IgG高水平组足突广泛融合及足细胞弥漫空泡变性比例均较低水平组高，差异有统计学意义(n P0.029) and low FE IgG group (FE IgG0.05). The remission time of high FE IgG group was (18.75±6.81)months, while it was (8.46±3.74)months in low FE IgG group, with significant difference (n P<0.01). There was no difference in remission time of immunosuppressive therapy and supportive therapy in low FE IgG group (n P=0.265), bo-th of which were lower than the high-level immunosuppressive therapy group (n P<0.001). The remission time of tacrolimus was shorter than that of cyclophosphamide in high FE IgG group, but with no significant difference (n P=0.131). There was significant difference in the remission time of tacrolimus between the high and low level groups of FE IgG (n P<0.01). Under electron microscope, the ratio of foot process fusion and podocyte diffuse vacuolar degeneration in the high level group of FE IgG was higher than that in the low level group (n P<0.01).n Conclusions:FE IgG can be used as a clinical indicator for predicting drug responsiveness and remission in patients with IMN, and is essential for early identification of high-risk patients and for making clinical decisions. Patients with high FE-IgG may benefit from early initiation of immunosuppressive therapy.