肾穿刺活检610例患者的临床病理特点分析

发布时间：2018-06-15 07:45

本文选题：穿刺术 + 慢性肾脏病　；参考：《中国全科医学》2015年14期

【摘要】：目的分析肾穿刺活检患者的临床病理特点。方法收集2004—2014年于大连医科大学附属第二医院住院的610例行肾穿刺活检的慢性肾脏病(CKD)患者,参照WHO(1982年及1995年)肾小球疾病组织学分类方法,结合患者临床资料、实验室检查结果及肾脏病理明确诊断。观察不同性别、不同年龄段各型CKD发生率及2004—2008年和2009—2014年CKD类型变化。结果 610例CKD患者中,原发性肾小球疾病(PGD)468例,其中Ig A肾病(Ig AN)153例(32.7%)、膜性肾病(MN)131例(28.0%)、系膜增生性肾小球肾炎(Ms PGN)122例(26.1%)、肾小球微小病变(MCD)31例(6.6%)、局灶节段性肾小球硬化(FSGS)27例(5.8%)、膜增生性肾炎(MPGN)2例(0.4%)和新月体性肾小球肾炎(CREGN)2例(0.4%);继发性肾小球肾炎(SGN)142例,其中乙型肝炎病毒相关性肾炎51例(35.9%)、狼疮性肾炎(LN)38例(26.8%)、紫癜性肾炎(HSPN)35例(24.7%)、血管性疾病所致肾损害6例(4.2%)、多发性骨髓瘤相关肾损害5例(3.5%)、肥胖相关性肾损害3例(2.1%)、干燥综合征肾损害2例(1.4%)、系统性硬化肾损害1例(0.7%)、硬皮病肾病1例(0.7%)。男性Ig AN发生率低于女性,MN发生率高于女性(P0.05);其余不同性别各型PGD发生率比较,差异无统计学意义(P0.05)。男性LN发生率低于女性(P0.05);其余不同性别各型SGN发生率比较,差异无统计学意义(P0.05)。不同年龄段Ig AN、MN、MCD、乙型肝炎病毒相关性肾炎、HSPN、血管性疾病所致肾损害发生率比较,差异有统计学意义(P0.05)。2009—2014年MN发生率高于2004—2008年(P0.05);其余不同年度各型PGD发生率比较,差异无统计学意义(P0.05)。不同年度各型SGN发生率比较,差异无统计学意义(P0.05)。结论 PGD中常见Ig AN,SGN中常见乙型肝炎病毒相关性肾炎;10年间CKD增长幅度较高的为MN,为临床预防和治疗提供了参考依据。
[Abstract]:Objective to analyze the clinicopathological features of renal biopsy. Methods 610 patients with chronic kidney disease (CKD) who were hospitalized in the second affiliated Hospital of Dalian Medical University from 2004 to 2014 were collected. According to the histological classification method of glomerular diseases in WHO (1982 and 1995), the clinical data of the patients were analyzed. The results of laboratory examination and renal pathology were clearly diagnosed. The incidence of CKD and the changes of CKD between 2004-2008 and 2009-2014 were observed. Results among 610 patients with CKD, 468 had primary glomerular disease. Among them, there were 153 cases of IgA nephropathy with IgA nephropathy, 131 cases with membranous nephropathy and 28.0%, 122 cases with Mesangial proliferative glomerulonephritis with MS PGNN, 122 cases with Mesangial proliferative glomerulonephritis (MS PGNN), 31 cases with MCDT with minimal change of glomeruli, 27 cases with focal segmental glomerulosclerosis, 27 cases with FSGSU, 2 cases with membranous proliferative glomerulonephritis, 2 cases with MPGNN, and 2 cases with small crescent glomerulonephritis. There were 2 cases of glomerulonephritis and 142 cases of secondary glomerulonephritis. There were 51 cases of hepatitis B virus associated nephritis, 38 cases of lupus nephritis, 35 cases of HSPNN, 35 cases of HSPN, 6 cases of renal damage caused by vascular diseases, 5 cases of multiple myeloma associated renal damage and 3 cases of obesity associated renal damage. There were 2 cases of Sjogren's syndrome with renal damage, 1 case with systemic sclerosing kidney damage, 1 case with scleroderma nephropathy and 1 case with scleroderma nephropathy. The incidence of IgAN in males was lower than that in females, but there was no significant difference in the incidence of PGD in other genders. The incidence of LN in males was lower than that in females, but there was no significant difference in the incidence of SGN in other sexes. There were significant differences in the incidence of renal damage caused by vascular diseases between different age groups (Ig ANN MNCD, hepatitis B virus associated glomerulonephritis (HSPNN) and vascular diseases). The incidence of MN in 2009-2014 was higher than that in 2004-2008 (P 0.05), and the incidence of other types of PGD in different years was higher than that in 2004-2008. The difference was not statistically significant (P 0.05). There was no significant difference in the incidence of SGN in different years (P 0.05). Conclusion the increase of CKD in PGD is MNs, which provides a reference for clinical prevention and treatment of hepatitis B virus associated glomerulonephritis (HBV-associated glomerulonephritis).
【作者单位】：大连医科大学附属第二医院;
【分类号】：R692

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