4862例肾活检患者临床与病理资料分析

发布时间：2019-01-13 08:59

【摘要】：目的:本研究通过对4862例肾活检患者的临床和病理资料进行回顾性分析,总结本地区肾活检患者的年龄和性别特征、病理类型分布特点以及病理类型与临床诊断之间的关系,并比较2007-2011年、2012-2016年肾活检疾病谱变化,为本地区肾脏疾病的诊治提供有价值的资料。方法:回顾性分析2007年1月1日至2016年12月31日于吉林大学第二医院肾病内科进行肾穿刺活检的4862名患者的临床及病理资料,并根据性别、年龄、肾活检时间、临床诊断、病理诊断等分组,分析病理类型分布和变化以及临床诊断与病理资料之间的关系。结果:本组患者以男性居多(52.92%),男女比例为1.12:1,除继发性肾脏疾病和遗传性肾病外,男性患者均多于女性。肾活检患者平均年龄为41.59±15.66岁,主要发病人群为青壮年,平均年龄有增长趋势,且老年肾活检患者的比例明显增高。原发性肾小球疾病的发病率最高(73.49%),其次为继发性肾脏疾病(23.34%)。原发性肾小球疾病中最常见的病理类型是IgA肾病(32.33%)和膜性肾病(32.21%),与2007-2011年相比,2012-2016年膜性肾病检出率明显增高,超过IgA肾病。继发性肾脏疾病最常见的病理类型是狼疮性肾炎(34.01%)。肾活检患者最常见的临床诊断为肾病综合征(43.83%),其次为慢性肾小球肾炎(36.20%),慢性肾衰竭(13.04%)。病理类型与临床诊断不一一对应,如肾病综合征在原发性肾小球疾病中最常见的病理类型是膜性肾病(47.78%),在继发性肾脏疾病中最常见的病理类型是狼疮性肾炎。肾活检能对疾病的临床诊断起进一步修正作用。超微病理对最终的肾脏病理诊断起决定、修正和补充作用共占35.62%。结论:1、本中心肾活检患者平均年龄有增长趋势,老年肾活检患者的比例明显增高。2、肾活检患者病理类型以原发性肾小球疾病为主,膜性肾病发病率逐年升高,IgA肾病发病率逐年递减,近五年膜性肾病发病率超过IgA肾病;狼疮性肾炎是继发性肾脏疾病最常见的病理类型;肾病综合征和慢性肾小球肾炎是肾活检患者最常见的临床诊断。3、肾穿刺活检对疾病的临床诊断有修正作用;超微病理诊断对肾脏病理的最终结果有重要影响。
[Abstract]:Objective: to analyze retrospectively the clinical and pathological data of 4862 patients with renal biopsy, and to summarize the age and sex characteristics, the distribution of pathological types and the relationship between pathological types and clinical diagnosis. The disease spectrum of renal biopsy from 2007 to 2011 was compared in order to provide valuable data for the diagnosis and treatment of renal diseases in this area. Methods: the clinical and pathological data of 4862 patients who underwent renal biopsy from January 1, 2007 to December 31, 2016 in the Department of Nephrology, second Hospital of Jilin University were retrospectively analyzed. The data were analyzed according to sex, age, time of renal biopsy and clinical diagnosis. The distribution and changes of pathological types and the relationship between clinical diagnosis and pathological data were analyzed. Results: most of the patients were male (52.92%), the ratio of male to female was 1.12: 1. Except for secondary renal disease and hereditary nephropathy, male patients were more than female. The average age of renal biopsy patients was 41.59 卤15.66 years old. The incidence of primary glomerular disease was the highest (73.49%), followed by secondary renal disease (23.34%). The most common pathological types of primary glomerular diseases were IgA nephropathy (32.33%) and membranous nephropathy (32.21%). Compared with 2007-2011, the detection rate of membranous nephropathy in 2012-2016 was significantly higher than that in IgA nephropathy. The most common pathological type of secondary renal disease was lupus nephritis (34.01%). The most common clinical diagnosis of renal biopsy was nephrotic syndrome (43.83%), chronic glomerulonephritis (36.20%) and chronic renal failure (13.04%). The most common pathological type of nephrotic syndrome in primary glomerular diseases is membranous nephropathy (47.78%), and the most common pathological type in secondary renal diseases is lupus nephritis. Renal biopsy can further correct the clinical diagnosis of disease. Ultrastructural pathology plays an important role in the final diagnosis of renal pathology. Conclusion: 1, the average age of renal biopsy patients in this center has an increasing trend, and the proportion of elderly renal biopsy patients is obviously increased. 2. The pathological types of renal biopsy patients are mainly primary glomerular diseases, and the incidence of membranous nephropathy is increasing year by year. The incidence of IgA nephropathy decreased year by year, and the incidence of membranous nephropathy was higher than that of IgA nephropathy in recent five years. Lupus nephritis is the most common pathological type of secondary renal disease, nephrotic syndrome and chronic glomerulonephritis are the most common clinical diagnosis of renal biopsy. Ultrastructural pathological diagnosis plays an important role in the final outcome of renal pathology.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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