610例肾穿刺活检患者临床与病理类型分析

发布时间：2018-04-05 23:00

本文选题：肾活检　切入点：肾小球疾病　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：分析我院610例行肾穿刺活检的患者的性别、年龄、病理类型及临床表现,为疾病的诊治提供有价值的资料。方法：收集2004年1月～2014年1月于大连医科大学附属第二医院住院的610例行肾活检的患者的临床表现、实验室检查等资料，参照WHO1982年及改良的1995年肾小球疾病组织学分型修订方案,结合临床资料、实验室检查结果及肾脏病理明确诊断，对患者的年龄、性别及原发病的构成、肾脏病理类型进行统计，，并比较我院2004年1月～2014年1月前后5年肾脏病理类型的变化。结果:1.共收集610例患者，原发性肾小球疾病（PGD）468例占（76.72%）,继发性肾小球疾病(SGN)142例占（23.28%），PGD中IgA肾病(IgAN)占（32.69%），其次分别为膜性肾病(MN)占（27.99%），系膜增生性肾小球肾炎肾炎(MsPGN)(26.06%);SGN中最常见的3种疾病依次为:乙肝病毒相关性肾小球肾炎占（35.91%）,狼疮性肾炎占（26.76%）,过敏性紫癜性肾炎占（24.64%）。 2.性别分布特点：男性306例占(50.16%),女性304例占(49.84%)。在PGD中男性248例占（52.99%），女性220例占（47.01%），在SGN中，男性58例占（40.85%），女性84例占（59.15%），原发性肾小球疾病和继发性肾小球疾病男女分布有显著差异（P0.01）。 3.年龄分布特点：原发性肾小球疾病在25～34岁年龄组所占比例最高,IgAN、MsPGN和局灶节段肾小球硬化（FSGS）3种在25～34岁年龄组所占比例最高；MN在55～64岁年龄组所占比例明显高于另外5种病理类型。继发性肾小球疾病中以35～44岁年龄组发病最多.狼疮性肾炎在25～34岁年龄组所占比例最高；过敏性紫癜性肾炎在14～34岁年龄组所占比例最高；乙肝病毒相关性肾炎则以35～44岁年龄组所占比例最高。 4.分析前后5年间原发性肾小球肾炎病理改变，存在统计学意义（P0.01）,2009～2014年间MN检出率提高明显，与其他病理类型比较存在统计学意义（P0.05）。而继发性肾小球疾病病因变化从总体上看无显著统计学意义（P0.05）。 5.病理类型及临床表现关系，本组患者肾病综合征(NS)(44.10%)最为常见，其次是肾炎综合征(GH)(39.20%)、慢性肾功能衰竭(14.60%)、急性肾功能衰竭(ARF)(1.80%)、隐匿性肾小球肾炎（0.30%）。结论：1.原发性肾小球疾病是最常见的肾小球疾病,其中IgA肾病所占比例最高,膜性肾病发病率升高；乙肝病毒相关性肾炎是继发性肾小球肾炎最常见的病因。 2.青壮年为肾小球肾炎的高发人群，继发性肾小球疾病男女比例存在明显差异,并且以女性占优势。 3.肾病综合症是最常见的临床分型。
[Abstract]:Objective: to analyze the sex, age, pathological type and clinical manifestation of 610 cases of renal biopsy in our hospital, and to provide valuable data for diagnosis and treatment of the disease.Methods: from January 2004 to January 2014, 610 cases of renal biopsy were collected from the second affiliated Hospital of Dalian Medical University.According to the revised histological classification scheme of glomerular diseases in WHO1982 year and modified 1995, combined with clinical data, laboratory results and renal pathology, the age, sex, constitution of primary disease and renal pathological type were statistically analyzed.The changes of renal pathological types in our hospital from January 2004 to January 2014 were compared.The result is 1: 1.A total of 610 patients were collected.Liver virus-associated glomerulonephritis accounted for 35.91%, lupus nephritis 26.76%, Henoch-Schonlein purpura nephritis 24.64%.2.Sex distribution: 306 cases of males and 304 cases of females accounted for 50.16% and 49.84% respectively.In PGD, there were 248 males (52.99g) and 220 females (47.01%). In SGN, 58 males (40.85%) and 84 females (59.1515%) had significant differences in the distribution of primary glomerular diseases and secondary glomerular diseases (P 0.01).3.Age distribution: the proportion of primary glomerular diseases in the age group of 25 to 34 years old was the highest, and the proportion of IgANMsPGN and FSGSN in the age group of 25 to 34 years old was the highest. The proportion of MN in the age group of 55 to 64 years old was significantly higher than that of the other five pathological types.The incidence of secondary glomerular diseases was the highest in the age group of 35 to 44 years old.The proportion of lupus nephritis was the highest in the age group of 25 ~ 34 years old, the proportion of Henoch-Schonlein purpura nephritis group was the highest in the age group of 14 ~ 34 years, and the proportion of hepatitis B virus associated glomerulonephritis group was the highest in the age group of 35 ~ 44 years old.4.The pathological changes of primary glomerulonephritis in the five years before and after analysis showed that the detection rate of MN increased significantly between 2009 and 2014, and there was statistical significance compared with other pathological types.The etiological changes of secondary glomerular diseases were not statistically significant (P 0.05).5.The pathological types and clinical manifestations were most common in this group of patients with nephrotic syndrome (NS44.10), followed by glomerulonephritis syndrome (GHN) 39.20%, chronic renal failure (CRF) 14.60%, acute renal failure (ARFN) 1.80%, occult glomerulonephritis (0.30).Conclusion 1.Primary glomerular disease is the most common glomerular disease in which IgA nephropathy accounts for the highest incidence of membranous nephropathy and hepatitis B virus associated glomerulonephritis is the most common cause of secondary glomerulonephritis.2.The male and female ratio of secondary glomerulonephritis was significantly different in the young and adult population with high incidence of glomerulonephritis.3.Nephrotic syndrome is the most common clinical classification.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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