肾活检患者肾脏病构成十年对比分析

The prevalence of biopsy-proven renal diseases in adults between two periods over the past 10 years

目的 分析我科成人肾活检患者各种肾脏病的构成比例、10年来的变化特点及其意义。方法 对在我科经临床病理讨论获得诊断的全部成人患者的临床及病理资料进行断面对比分析 ,1990年 1月～ 1991年 12月共 2 14例 ,2 0 0 0年 1月～ 2 0 0 1年 12月共 15 2 5例。结果 (1)接受肾活检患者人数明显增加 ,年龄增高 ,从 (3 0 .6± 11.1)岁增至 (3 5 .2± 13 .9)岁 ,老年患者的比例从0 .5 %增至 6.8% ;(2 )急性肾衰竭 (ARF)比例明显增加 (7.5 %至 14 % ) ;(3 )疾病构成中 ,虽仍以原发性肾小球疾病为主 ,但所占比例已明显下降 (77.6%至 65 .4% ) ,继发性肾脏病及肾小管和肾间质疾病增加 ;(4 )在原发性肾小球疾病中 ,IgA肾病所占比例明显增多 (16.9%至 47% ) ,占大量蛋白尿患者的 15 % ,肾炎综合征的 49.6% ,单纯血尿的 42 .3 %。局灶节段性肾小球硬化无增加 ;(5 )继发性肾小球疾病仍以狼疮性肾炎 (从 5 7.1%降至 3 9.4% )、乙型肝炎病毒相关性肾炎 (15 .4% )和紫癜性肾炎 (15 .4)为主 ,原发性小血管炎肾损害 (从 0增至 10 .2 % )及高血压肾损害 (从 0增至 6.1% )增多 ;(6)ARF中 ,重症急性肾小球肾炎的比例明显下降 ,急性间质性肾炎 (多与药物相关 )、原发性小血管炎肾损害和恶性高血压肾损害比例增加。

Objective To understand the composing characteristics and changing tendency of renal diseases proven by renal biopsy.Methods 214 cases from January 1990 to December 1991 and 1525 cases from January 2000 to December 2001 were enrolled in this study.Their clinical and pathological data were retrospectively analyzed.Results During this period:①the cases with biopsy-proven renal diseases were increased by 710% in our department.Their average age increased from 30.6±11.1 years to 35.2±13.9 years.The old patients increased from 0.5% to 6.8%.②acute renal failure (ARF) increased from 7.5% to 14%.③Primary glomerular diseases decreased from 77.6% to 65.4%,while secondary renal diseases and renal tubulointerstitial diseases increased.④IgA nephropathy increased significantly (from 16.9% to 47%),which accounted for 15% patients with massive proteinuria,49.6% patients with nephritic syndrome,42.3% patients with isolated hematuria.Focal segmental glomerulosclerosis remained low frequencies.⑤in secondary renal diseases,the main diseases still were lupus nephritis (decreasing from 57.1% to 39.4%),HBV associated glomerulonephritis(15.4%) and glomerulonephritis of Henoch-Scholein purpura (15.4%),while primary vasculitis (from 0 to 10.2%) and hypertensive nephropathy ( from 0 to 6.1%)increased significantly.⑥For ARF patients, severe acute glomerulonephritis decreased significantly,while acute tubulointerstitial nephritis (most associated with drug-abused),primary vasculitis and renal injuries of malignant hypertension increased.Conclusions Without the change of renal biopsy policy,the spectrum change of renal diseases over the past 10 years could be due to our improved diagnostic level and changes of actual incidence of the diseases.