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目的:探讨成人薄基底膜肾小球病（thin basement membrane nephropathy，TBMN）的临床病理特征及预后。方法:选取2008年1月1日至2017年12月31日在东部战区总医院肾脏科经肾活检确诊为TBMN的成年患者，回顾性分析临床、病理特点和预后，以及蛋白尿和肾脏慢性病理改变的影响因素。结果:共纳入135例TBMN患者，女性116例（85.9%），男性19例（14.1%），年龄（40.56±10.30）岁，30例（22.2%）合并高血压，32例（23.7%）合并超重/肥胖。135例患者均有镜下血尿，血清肌酐均正常，41例（30.4%）存在蛋白尿[（0.65±0.19）g/24 h]。102例（75.6%）肾脏病理可见肾小球硬化，其中51例（37.8%）球性硬化比例>10%。79例（58.5%）存在轻度肾小管间质慢性病变，53例（39.3%）存在血管透明变性。合并超重/肥胖和（或）高血压患者的蛋白尿、肾小管间质慢性病变及肾血管病变比例均高于无合并症组（均n P10%. There were 79 cases (58.5%) with mild chronic tubulointerstitial lesions, and 53 patients (39.3%) with vascular hyalinosis. The proportions of proteinuria, chronic tubular interstitial lesion and renal vascular lesion in patients with overweight/obesity and/or hypertension were higher than those without complications (alln P<0.05). Multivariate logistic regression results showed that overweight/obesity (n OR=7.550, 95% n CI 2.091-27.257, n P=0.002) and hypertension (n OR=4.424, 95% n CI 1.091-17.935, n P=0.037) were independent influencing factors for proteinuria, while proteinuria was the independent influencing factor for chronic tubular interstitial lesion (n OR=3.151, 95% n CI 1.046-9.491, n P=0.041). Four patients were lost to follow-up, and the median follow-up time of the remaining patients was 64.0(24.0, 96.5) months. At the end of the follow-up, urine protein increased in 10 patients (7.4%) and estimated glomerular filtration rate decreased in 3 patients (2.2%). The above 13 cases were all complicated with overweight/obesity and 4 cases with hypertension. The urine test and renal function in the remaining 118 patients didn't change significantly from baseline.n Conclusions:The incidences of proteinuria and renal chronic lesion are high in adult TBMN patients. Overweight/obesity and hypertension may cause a poor prognosis, and TBMN patients without metabolic abnormalities probably have good prognosis, but need long-term follow-up.