单中心自体肾经皮肾穿刺活检临床病理特点的10年总结

发布时间：2018-07-25 15:25

【摘要】：目的回顾性分析单中心10年间成人肾活检资料的流行病学、临床特征和病理类型的分布特点,比较分析不同时期肾活检病理诊断谱的变化情况,初步探讨10年间肾活检流行病学特点的变化。方法选择2007年1月至2016年12月在我科行肾穿刺活检的15岁及以上的病例,根据时间分为2007—2010年(前期组)、2011—2013年(中期组)和2014—2016年(近期组)3个时间组,根据年龄分为15~39岁组、40~64岁组和65岁及以上组。收集并采用SPSS 18.0软件分析所有患者的临床病理资料。结果共入选1 786例临床病理资料完整的肾活检病例。男性973例,女性813例,中位年龄42(15~88)岁。原发性肾小球疾病1 548例,其中IgA肾病最常见,占所有病例的29.1%(520/1 786),微小病变肾病占17.3%(309/1 786),膜性肾病占17.0%(304/1 786)。继发性肾脏疾病238例,其中最常见的为狼疮性肾炎,占所有肾活检病例的3.4%(61/1 786),其次为糖尿病肾病(2.9%,51/1 786)和紫癜性肾炎(2.2%,39/1 786)。3个时期组患者性别、年龄差异无统计学意义;中期组(90/547,16.5%)和近期组(148/555,26.7%)膜性肾病比例高于前期组(66/684,9.6%;P0.01)。所有病例的临床表现以肾炎综合征最常见(812/1 786,45.5%),肾病综合征次之(688/1 786,38.5%)。15~39岁组以肾病综合征为临床表现的病例中最常见的为微小病变肾病(122/295,41.4%),40~64岁组和65岁及以上组最常见的为膜性肾病(122/312,39.1%;36/81,44.4%)。15~39岁组和40~64岁组肾炎综合征最常见的病理诊断均为IgA肾病(227/403,56.3%;144/381,37.8%),65岁及以上组为膜性肾病(9/28,32.1%)。结论 IgA肾病是最常见的肾小球疾病,近年来膜性肾病的发病率有显著升高的趋势,值得关注。IgA肾病是中青年肾炎综合征病例最常见的病理诊断,膜性肾病是中老年肾病综合征病例最常见的病理诊断。
[Abstract]:Objective to retrospectively analyze the epidemiology, clinical features and pathological types of renal biopsy data in adults during the past 10 years, and to compare and analyze the changes of pathological diagnosis spectrum of renal biopsy in different periods. Objective: to investigate the epidemiological characteristics of renal biopsy in 10 years. Methods from January 2007 to December 2016, the patients aged 15 and above who underwent renal biopsy in our department were divided into three groups according to the time: 2007-2010 (Prophase group), 2011-2013 (interim group) and 2014-2016 (recent group). According to the age, they were divided into 1539 years old group, 4064 years old group and 65 years old and above group. The clinicopathological data of all patients were collected and analyzed by SPSS 18.0 software. Results A total of 1,786 renal biopsy cases with complete clinicopathologic data were selected. There were 973 males and 813 females with a median age of 42 (1588) years. Of the 1 548 cases of primary glomerular disease, IgA nephropathy was the most common, accounting for 29.1% (520 / 1,786) of all cases, minimal lesion nephropathy 17.3% (309 / 1,786), membranous nephropathy 17.0% (304 / 1,786). Among 238 cases of secondary renal diseases, lupus nephritis was the most common one, accounting for 3.4% (61 / 1,786) of all renal biopsy cases, followed by diabetic nephropathy (2.9%) and Henoch-Schonlein purpura nephritis (2.2% / 391,786). The percentage of membranous nephropathy in the metaphase group (90 / 547 / 16.5%) and the recent group (148 / 555 ~ 26.7%) was higher than that in the pre-stage group (66 / 684 / 9.6 / P0.01). The most common clinical manifestations of all cases were nephritis syndrome (812 / 1786 / 45.5%), nephrotic syndrome (688 / 1786 / 38.5%) .1539 years old group with nephrotic syndrome as the most common clinical manifestations of minimal change nephropathy (122 / 2951.4%) 4064 years old group and 65 years old and over group the most common. The most common pathological diagnosis of glomerulonephritis syndrome in 1539 years old group and 4064 years old group was IgA nephropathy (227 / 403 / 56.43 / 37.8%) and membranous nephropathy (92832.21%) in 65 years old and over. Conclusion IgA nephropathy is the most common glomerular disease. In recent years, the incidence of membranous nephropathy has a significant increasing trend, and it is worthy of attention that .IgA nephropathy is the most common pathological diagnosis in young and middle-aged patients with glomerulonephritis syndrome. Membranous nephropathy (MNS) is the most common pathological diagnosis in middle-aged patients with nephrotic syndrome.
【作者单位】：第二军医大学长海医院肾内科;
【基金】：国家自然科学基金(81600550) 上海市卫生与计划生育委员会青年科研项目(2012Y104)~~
【分类号】：R692

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