原发性肾小球疾病病理类型的变化趋势

发布时间：2018-03-05 09:41

  本文选题：慢性肾脏病　切入点：原发性肾小球疾病　出处：《山东大学》2016年博士论文　论文类型：学位论文

【摘要】：慢性肾脏病(Chronic Kidney Disease,CKD)已经成为一个全球关注的公共健康问题。综合文献报道慢性肾脏病的发病率高达每年每百万人群中有200例-400例。大多数慢性肾脏病起病及进展缓慢,症状隐匿,患者往往在“无症状”中,“突然”进入终末期肾病(End Stage Renal Disease,ESRD)。慢性肾脏病被医务人员称为“沉默的杀手”。患者一旦进入终末期肾病,就需要给予肾脏移植、血液透析或腹膜透析等花费高昂的肾脏替代治疗,患者生命依赖医院的程度明显增加,给患者本人及家庭、社会造成巨大精神及经济压力。北京大学第一医院组织的多中心的全国性调查研究发现,我国慢性肾脏病的发病率为10.8%一13%.其他发达国家慢性肾脏病的发病率与我国相近,比如,美国截止到2004年的数据显示慢性肾脏病的发病率已逐年增加至13.1%。由于它的高发病率、低知晓率、预后差、花费巨大等特点,慢性肾脏病越来越引起人们的重视。最近一些研究表明在中国接受肾脏穿刺活检病理检查的患者中原发性肾小球疾病仍然是最为常见的肾脏疾病。原发性肾小球疾病在接受肾脏穿刺活检的病理类型中占63.3%--71.1%。数量有限的单中心小规模研究表明近年来原发性肾小球疾病肾脏病理类型的比例不断的发生着变化。变化之一是膜性肾病及IgA肾病的发病率显著增加,但IgA肾病在中国及其他一些国家仍是最为常见的慢性肾小球疾病。研究发现IgA肾病在亚洲、欧洲、大洋洲中的发病率最高占原发性肾小球疾病的36.8-54.2%。但在同一时期,另有一些研究并未发现相同的趋势。据我们所知,我国最近的肾脏疾病病理谱变化的统计分析要追溯至2012,至今3年过去了,是否有新的变化呢?另外,目前的研究都是小规模的单中心研究,为了能够更加深入的分析最新的原发性肾小球疾病病理类型的变化,我们收集了来自山东省2家大型肾脏病理检查中心共37家医院最近5年的肾脏穿刺病理结果进行统计分析。研究目的：在中国,原发性肾小球疾病仍是最为常见的肾脏疾病类型。数量有限的单中心小规模分析研究表明膜性肾病发病率逐年升高。然而,IgA肾病仍是最为常见的原发性肾小球疾病。剧我们所知,目前在中国还没有关于原发性肾小球疾病谱变化的多中心研究。为更加深入的研究肾脏组织病理类型变化,收集了来自山东省2家大型肾脏病理检查中心37家医院近5年的肾脏穿刺病理结果进行统计分析。以期发现肾脏病理疾病谱的最新变化趋势。研究方法：在这个横断面回顾性研究中,我们选取2010年6月到2015年5月来自山东省两家大型肾脏病理中心(山东省千佛山医院病理科及济南银丰医学研究中心)共37家医院6017名接收肾穿刺的患者作为研究对象进行统计分析。剔除一般资料记录不完整的21人,剔除肾组织标本不充分的44人(即光镜下肾小球小于10个,并且免疫荧光或电镜下没有典型发现者),剔除重复肾活检标本17人。因此,在此回顾性研究中纳入5935个合格的样本。其中,4855(81.8%)病人诊断为原发性肾小球疾病。根据患者年龄分为4个组别(儿童患者组≤18岁,青年患者组19-44岁,中年患者组45-59岁,老年患者组≥60岁)。以1年为一个时间间隔共分为5个阶段进行统计分析。研究结果：在4855例原发性肾小球疾病患者中,2610(53.8%)为男性,2245(46.2%)为女性。肾组织样本患者的平均年龄为39.78±15.43岁(从1岁到88岁)。5个时期中平均年龄分别为39.3±14.4岁,38.1±13.9岁,39±15.8岁,40.2±16.1岁,41.6±15.9岁。根据年龄分层分析提示原发性肾小球肾炎在青年患者(19-44岁)中发病率最高,2623例(54.0%),其他依次是中年患者(45-59岁)1317例(27.1%),老年患者(≥60岁)555例(11.4%),儿童患者(≤18岁)349例(7.2%)。在整个研究时期和不同阶段原发性肾小球疾病的病理类型变化：在4855个原发性肾小球疾病患者中,占首位的病理类型是膜性肾病(2103,43.3%),其他依次是IgA肾病(1655,34.1%),微小病变(488,10.3%),局灶节段性肾小球硬化(332,6.8%),膜增生性肾小球肾炎(64,1.3%),硬化性肾小球肾炎(49,1.0%),新月体性肾小球肾炎(45,0.9%),毛细血管内增生肾小球肾炎(37,0.8%)和系膜增生性肾小球肾炎(27,0.6%)。根据年度分段后发现膜性肾病的的比例逐年明显增加,依次为30.7%,34.5%,39.4%,50.7%,53.5%。另外,从第3年度开始膜性肾病取代IgA肾病成为原发性肾小球疾病的最主要病理类型。IgA肾病在第1、2年是原发性肾小球疾病的最主要病理类型。然而,其比例从第2年的41.8%逐年下降至第5年的25.2%(p0.001)。局灶节段性肾小球硬化性肾小球疾病的比例从第2年的11.1%下降至第5年的4.1%。微小病变的比例在第1年最高为17.8%,但第5年下降至9.6%。根据年龄分层后原发性肾小球疾病的病理类型变化：根据年龄分层后分析发现,随着年龄的增加,膜性肾病的比例显著增加,依次为儿童患者29.8%,青年患者38.3%,中年患者48.6%,老年患者63.2%。与之相反,微小病变呈现相反的走势。IgA肾病于青年患者中发病率最高(38.5%),随着年龄增加其比例不断下降,至老年的(18.9%)。根据年龄分层后分析发现,在每个年龄层面膜性肾病的比例均呈现逐年增加的趋势。然而,IgA肾病所占的比例几乎在每个年龄层面呈现相反的逐年下降趋势。此外,IgA肾病在青年人中发病率最高。在349位儿童患者(≤18岁)原发性肾小球疾病中,排在首位的病理类型为IgA肾病(121,34.7%),其他依次为膜性肾病(104,29.8%),微小病变(71,20.3%),毛细血管内增生肾小球肾炎(16,4.6%),局灶节段硬化性肾小球疾病(15,4.3%),膜增生性肾小球肾炎(6,1.7%),硬化性肾小球疾病(5,1.4%),新月体性肾小球肾炎(2,0.6%),系膜增生性肾小球肾炎(1,0.3%)。在青年患者中,IgA肾病是最常见的原发性肾小球疾病(38.5%),其他依次为膜性肾病(38.3%),微小病变(10.6%),局灶节段硬化性肾小球疾病(8%),硬化性肾小球疾病(1.1%),膜增生性肾小球肾炎(0.9%),新月体性肾炎(0.7%),系膜增生性肾小球肾炎(0.6%),毛细血管内增生性肾小球肾炎(0.5%)。在中年患者中,膜性肾病均成为最主要的病理类型(48.6%),其他依次为IgA肾病(31.5%),微小病变(8.0%),局灶节段硬化性肾小球疾病(6.4%),膜增生性肾小球肾炎(1.6%),新月体性肾小球肾炎(1.0%),硬化性肾小球疾病(0.8%),毛细血管内增生肾小球肾炎(0.5),系膜增生性肾小球肾炎(0.5%)。在老年患者中,膜性肾病均成为最主要的病理类型(63.2%),其他依次为IgA肾病(18.9%),微小病变(5.8%),局灶节段硬化性肾小球疾病(4.0%),膜增生性肾小球肾炎(2.5%),新月体性肾小球肾炎(2.0%),硬化性肾小球疾病(0.9%),毛细血管内增生肾小球肾炎(0.5%),系膜增生性肾小球肾炎(0.4%)。总之,在5935例合格的肾穿刺患者中,原发性肾小球疾病有4855例,占81.8%。其中膜性肾病(43.3%)成为最为常见的原发性肾小球疾病,而IgA肾病退至第二位(34.1%)(P0.001)。膜性肾病的发病率从第1年的30.7%增加到第5年的53.5%(P0.001)。膜性肾病的发病率在每个年龄阶段都呈现增加趋势。在第1、2年期间IgA仍然是原发性肾小球疾病的主要原因。然而,IgA所占比例明显下降,从第2年的41.8%下降至第5年的25.2%(p0.001)。研究结论：我们的分析研究表明,原发性肾小球疾病仍然是目前最为常见的肾脏疾病。在各个年龄层面,膜性肾病的发病率逐年增加,IgA的发病率逐年下降成为近5年原发性肾小球疾病病理类型比例变化的主旋律。我们目前的横断面研究首次表明膜性肾病取代IgA肾病成为原发性肾小球疾病的最主要的病理类型
[Abstract]:Chronic kidney disease (Chronic Kidney, Disease, CKD) has become a global public health concern. According to literature reported incidence of chronic kidney disease rate per million people in 200 cases of -400 patients. The majority of chronic kidney disease onset and slow progress, symptoms hidden, patients are often asymptomatic. "Suddenly" end-stage renal disease (End Stage Renal Disease, ESRD). Chronic kidney disease by the medical staff called the "silent killer". Once in the patients with end-stage renal disease, we need a kidney transplant, hemodialysis or peritoneal dialysis and costly renal replacement therapy, patients with life on hospital increased significantly, to patients and their families, society caused great spiritual and economic pressure. The study of national survey center of No.1 Hospital of Peking University of the organization found that China's incidence of chronic kidney disease rate was 1 0.8% other developed countries 13%. incidence of chronic kidney disease was similar, and in China for example, the United States by the end of 2004 data show that the incidence of chronic renal diseases has increased to 13.1%. because of its high incidence, low awareness rate, poor prognosis, costly features, more and more people with chronic kidney disease attention. Recently some studies show that received renal biopsy in patients with primary glomerular disease in China is still the most common kidney disease. Primary glomerular diseases accounted for the single center study of small scale 63.3%--71.1%. in a limited number of pathological types of renal biopsy in accepting that in recent years the primary renal glomerular diseases the proportion of type changing. One of the changes is a significant increase in the incidence of membranous nephropathy and IgA nephropathy, IgA nephropathy and other Chinese but in some countries still Is the most common chronic glomerular disease. The study found that IgA nephropathy in Asia, Europe, the incidence in Oceania accounted for the highest rate of primary glomerular disease 36.8-54.2%. but at the same time, some studies have not found the same trend. As far as we know, the statistical changes in China's recent kidney pathological spectrum analysis going back to 2012, since the past 3 years, whether there are new changes? In addition, the present study is a single center study of small scale, in order to more in-depth analysis of the new type of primary glomerular disease pathological changes, we collected from Shandong Province, 2 large renal pathology center with a total of 37 hospitals in the recent 5 years renal biopsy pathological results were statistical analysis. The purpose of this study is to Chinese, primary glomerular diseases are the most common type of kidney disease. A limited number of small single center Analysis shows that membranous nephropathy incidence increased year by year. However, the most common primary glomerular disease, IgA nephropathy is still play. We know, at present in China no multicenter study on primary glomerular disease spectrum changes. The type of kidney disease changes as the research more in-depth, collected from Shandong Province, 2 large renal pathological examination center of 37 hospitals in nearly 5 years of renal biopsy pathological results were analyzed. In order to find out the latest trends of renal pathological disease. Methods: in this cross-sectional retrospective study, we selected from June 2010 to May 2015 from Shandong Province, two large renal pathological Center (Department of pathology Shandong Province, Qianfo Hill hospital and Ji'nan Yinfeng medical research center, a total of 37 hospitals) 6017 received renal biopsy patients as the research object were analyzed. The general information can eliminate 褰曚笉瀹屾暣鐨，

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