单中心753例经皮肾活检儿童临床与病理分析

发布时间：2018-06-28 04:20

本文选题：儿童 + 肾穿刺活检　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的将我院近20年期间保存完整的经皮肾活检儿童的临床资料及病理资料加以整理分析,对病理类型的分布、临床症状与病理类型的关系以及部分重复肾活检穿刺患儿病理的动态变化进行探讨和总结,充分认识经皮肾穿刺活检术在儿童肾脏疾病中的重要性,为临床工作中儿童肾脏疾病的正确诊断和规范治疗提供有参考价值的指导资料。研究方法回顾性分析1995～2015年山东省立医院儿科的753例肾脏疾病患儿病例。在超声的引导下,所有入选病例均进行经皮肾穿刺活检术,并对活检标本进行光镜染色(HE染色、PAS染色、PASM染色、Masson染色)、直接免疫荧光染色(IgA、IgG、IgM、Fibrin、Clq、C3),部分行乙型肝炎病毒抗原免疫组化染色及电镜检查。参考WHO在1982年制定的肾小球疾病组织学分型方案及后来改良的1995年版、中华医学会肾脏病分会在2001年制定的肾活检病理诊断标准对患儿做出病理诊断,参考2000年11月中华医学会儿科学分会肾脏病学组在珠海研讨会上制定的儿童肾脏疾病临床诊断标准对患儿做出临床诊断。并收集其主要的临床资料、病理资料及相关实验室检查结果等指标,对收集的相关资料进行仔细核实后,再有条理的依次录入计算机中。在EXCEL软件中建立整体的数据库,然后使用SPSS 22.0软件加以统计分析。结果1.在753例行经皮肾穿刺活检的患儿中,男性442例,女性311例,其中男:女比例为1.42:1,入选病例年龄在1.3-15岁之间,平均(8.72±2.47)岁。可分为4大类,包括原发性肾小球疾病(428例,占56.84%)、继发性肾小球疾病(306例,占40.63%)、遗传性肾脏疾病(17例,占2.26%)、肾小管间质性疾病(2例,占 0.27%)。2.在临床诊断中原发性肾病综合征的患儿最为常见,共219例,占29.08%,其他依次为紫癜性肾炎(193例,占25.63%)、急性肾炎综合征(134例,占17.79%)、狼疮性肾炎(84例,占11.16%)、孤立性血尿(34例,占4.52%)等。3.在病理类型中系膜增生性肾小球肾炎的患儿最为常见,共367例,占48.74%,其他依次为IgA肾病(154例,占20.45%)、微小病变(79例,占10.49%)、膜性肾病(40例,占5.32%)、局灶节段性肾小球硬化(24例,占3.19%)等。4.肾活检肾脏疾病的变化趋势:近20年间肾活检肾脏疾病构成比出现了一定变化,原发性肾小球疾病中局灶节段性肾小球硬化、IgA肾病、膜性肾病及微小病变在各阶段所占比例逐渐增加,系膜增生性肾小球肾炎所占比例逐渐减少;继发性肾小球疾病中乙型肝炎病毒相关性肾炎在各阶段所占比例显著减少。5.临床诊断与病理类型的关系:原发性肾小球疾病中最常见的临床诊断和病理类型分别为原发性肾病综合征和IgA肾病,继发性肾小球疾病中最常见的临床诊断和病理类型分别为紫癜性肾炎和系膜增生性肾小球肾炎,薄基底膜肾病和Alport综合征是最常见的两种遗传性肾脏疾病。6.重复肾活检:8例重复肾活检患儿的病理类型及临床症状均出现了一定的变化。7.提高临床诊断水平:肾穿刺活检术后根据肾脏组织病理结果纠正临床诊断287例,对于临床疾病初步诊断的修正率为38.1%。结论1.儿童肾脏疾病中是以原发性肾小球疾病为主,最常见的临床诊断和病理类型分别为原发性肾病综合征和系膜增生性肾小球肾炎。2.近20年间,原发性肾小球疾病中IgA肾病、局灶节段性肾小球硬化、微小病变及膜性肾病患儿的发病率呈现上升趋势,系膜增生性肾小球肾炎则较前下降;同时,继发性肾小球疾病中乙型肝炎病毒相关性肾炎的发病率呈显著下降趋势。3.儿童肾脏疾病的临床表现和病理类型并不完全一致,因此需综合考虑患儿的病理及临床资料,必要时行进一步的基因检测,才能做出正确的诊断,进而选择合适的治疗方案。4.重复肾穿刺活检有助于及时掌握患者病理类型的转化,从而相应的调整治疗方案。
[Abstract]:The purpose of this study was to analyze the clinical data and pathological data of the complete percutaneous renal biopsy in our hospital during the last 20 years. The distribution of pathological types, the relationship between the clinical symptoms and pathological types, and the pathological changes of the children with partial renal biopsy were discussed and summarized, and the percutaneous renal biopsy was fully recognized. The importance of the renal disease in children provides valuable guidance for the correct diagnosis and standardized treatment of children's renal diseases in clinical work. A retrospective analysis of 753 cases of children with renal diseases in the pediatric department of Shangdong Province-owned Hospital in 1995~2015 years. Under the guidance of ultrasound, all the selected cases were performed percutaneous Nephrology. Biopsy specimens were performed with light microscopy (HE, PAS, PASM, Masson), direct immunofluorescence staining (IgA, IgG, IgM, Fibrin, Clq, C3), some of the hepatitis B virus antigen immunohistochemical staining and electron microscopy. Reference WHO in 1982, the histological classification scheme of glomerular diseases and the later improvement of 1 The 995 Year Edition, the kidney disease branch of the Chinese Medical Association, made a pathological diagnosis of renal biopsy in 2001, and made a clinical diagnosis of children's kidney disease clinical diagnostic criteria established by the kidney disease group of the Chinese Medical Association in November 2000 at the Zhuhai Symposium and collected its main clinical diagnosis. Data, pathological data and the results of the related laboratory examination were carefully checked into the computer. The whole database was established in the EXCEL software, and then the SPSS 22 software was used for statistical analysis. Results 1. of the 753 cases of children with percutaneous renal biopsy, 442 cases were male. There were 311 female cases, of which male: female ratio was 1.42:1, the age of the selected cases was between 1.3-15 years, average (8.72 + 2.47) years old. It could be divided into 4 categories, including primary glomerular disease (428 cases, 56.84%), secondary glomerular disease (306 cases, 40.63%), hereditary renal disease (17 cases, 2.26%), and renal tubulointerstitial disease (2, 0.27%).2. in clinical Children were most common in the diagnosis of idiopathic nephrotic syndrome in 219 cases, accounting for 29.08%. The others were purpuric nephritis (193 cases, 25.63%), acute nephritis syndrome (134 cases, 17.79%), lupus nephritis (84 cases, 11.16%), isolated hematuria (34 cases, 4.52%) and other.3. in the pathological type of mesangial proliferative glomerulonephritis in children A total of 367 cases, a total of 48.74%, and the others were IgA nephropathy (154 cases, 20.45%), small lesions (79 cases, 10.49%), membranous nephropathy (40, 5.32%), focal segmental glomerulosclerosis (24, 3.19%) and other.4. renal biopsy changes: renal biopsy in the last 20 years had a certain change in renal biopsy, primary renal minor The proportion of focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy and minor lesions in all stages of the disease gradually increased, and the proportion of mesangial proliferative glomerulonephritis gradually decreased, and the proportion of hepatitis B Virus Related Nephritis in secondary glomerulonephritis significantly reduced the clinical diagnosis and pathological types of.5.. The most common clinical diagnosis and pathological types of primary glomerular diseases are primary nephrotic syndrome and IgA nephropathy. The most common clinical diagnosis and pathological types of secondary glomerular diseases are purpuric nephritis and mesangial proliferative glomerulonephritis respectively, and thin basement membrane nephropathy and Alport syndrome are the most common types of secondary glomerular disease. Two kinds of hereditary renal diseases.6. repeat renal biopsy: 8 cases of repeated renal biopsy of the pathological type and clinical symptoms have changed a certain amount of.7. to improve the clinical diagnosis: renal biopsy after renal biopsy correction of 287 cases of clinical diagnosis, the correction rate of primary diagnosis of clinical disease is 38.1%. conclusion 1. children The most common clinical diagnosis and pathological types are primary nephrotic syndrome and mesangial proliferative glomerulonephritis.2., the most common clinical diagnosis and pathological types are primary glomerulonephritis and mesangial glomerulonephritis. The incidence of IgA nephropathy, focal segmental glomerulosclerosis, small lesions, and membranous nephropathy in children with primary glomerular disease is increasing in 20 years. Trend, mesangial proliferative glomerulonephritis is lower than before, and the incidence of hepatitis B virus associated glomerulonephritis in secondary glomerulopathy is significantly decreased. The clinical and pathological types of renal diseases in.3. children are not completely consistent. Therefore, the pathological and clinical data of the patients need to be taken into consideration. Gene detection can make the correct diagnosis, and then select the appropriate treatment program.4. repeat renal biopsy can help to timely master the transformation of the patient's pathological type, and accordingly adjust the treatment plan.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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