浙大一院十年肾脏病理疾病谱特征分析

发布时间：2018-01-29 00:14

本文关键词： 肾活检病理疾病谱回顾性　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的回顾性分析浙江大学附属第一医院肾脏病中心近十年(2004-2013年)6687例因原位肾脏疾病行B超定位下经皮肾活检的肾脏疾病病理类型的分布特征,比较分析十年间肾脏病理疾病谱的特征变化,以期指导临床的诊治及预防。方法肾脏病理医师主要根据WH01995年肾小球疾病组织学分型及个别疾病相应标准将原位肾穿刺病理结果进行初步分类,结合患者的临床相关资料、实验室检查结果以及光镜、免疫荧光和电镜下的肾脏病理特点,提出初步的诊断假设,明确诊断需要与临床肾病医师共同讨论得到,最终统计得出十年来肾脏病理疾病谱的特征及变化。结果本中心近十年资料完全的成人原位肾活检病例共6687例,其中前五年2324例,后五年4363例。成人肾活检最常见的病理类型为原发性肾小球病(PGD)83.58%,其后依次为继发性肾小球病(SGD)13.94%,遗传性肾病(HN)0.15%,小管间质疾病(TID)1.59%,其它0.75%。比较前、后五年疾病谱发现,后五年PGD的比例明显下降,SGD的比例明显上升(P均0.05),而HN和TID比例改变则无显著性差异。成人PGD中最常见的工IgA肾病(IgAN)占53.91%,其后依次为膜性肾病(MN)17.93%,微小病变(MCD)7.57%,系膜增生性肾小球肾炎(MsPGN)7.50%,肾小球轻微病变(GML)4.33%,硬化性肾小球肾炎2.93%,局灶节段性肾小球硬化症(FSGS)2.04%,其余如局灶性肾炎(FGN),膜增生性肾小球肾炎(MPGN),新月体肾炎等所占比例较少。前后五年相比,MN、MCD、FSGS、IgAN比例明显上升(P均0.01),与之相反,GML、MsPGN比例明显下降(P均0.01)。SGD中最常见的类型狼疮性肾炎(LN)占40.88%,其次紫癜性肾炎(HSN)17.81%,系统性血管炎(SV)肾损害10.73%,糖尿病肾病(DN)9.98%,单克隆免疫球蛋白病肾损害7.09%(其中包括肾淀粉样变57例,轻链肾病(LCN)9例)。前后五年相比,LN的比例由40.20%下降至38.31%(P0.05),与之相反,DN和单克隆免疫球蛋白病肾损害的比例则明显上升(P0.05)。结论本研究是我中心大组肾脏病理资料的总结分析。结果显示PGD依然是成人原位肾活检中最常见的疾病类型,其中以IgAN最常见,成人SGD的比例近年来有增长趋势,其中LN最常见,DN和单克隆免疫球蛋白病肾损害的比例有所增加。本研究反映了浙江地区的肾活检疾病谱及变化趋势,将为肾脏病的临床诊治、预防及流行病学研究提供一定的依据。
[Abstract]:Objective To retrospectively analyze the pathological types of renal diseases in the first Affiliated Hospital of Zhejiang University in recent ten years ( 2004 - 2013 ) in 6687 cases of kidney disease caused by percutaneous renal biopsy under the condition of in situ kidney disease , and compare the characteristics of pathological changes of kidney in ten years , in order to guide the diagnosis and treatment of clinical diagnosis and prevention . Methods The pathological results of in situ renal biopsy were classified according to the corresponding standard of glomerular disease group and individual disease in WH01995 , the results of laboratory examination and the pathological characteristics of kidney under light microscope , immunofluorescence and electron microscope were combined . Results There were 6,87 cases of adult in - situ renal biopsy in recent 10 years . The most common pathological types in adult PGD were as follows : primary glomerular disease ( PGD ) 83.58 % , hereditary nephropathy ( HN ) 0.15 % , mesangial proliferative glomerulonephritis ( MsPGN ) 7.50 % , diabetic nephropathy ( HSN ) 7.57 % , mesangial proliferative glomerulonephritis ( MsPGN ) 7.50 % , diabetic nephropathy ( DN ) 9.98 % , renal impairment 7.09 % ( P0.05 ) . Conclusion PGD is the most common type of renal biopsy in adult in situ . The results showed that PGD was the most common type of renal biopsy in adult .

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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