成人肾小球疾病145例临床病理分析

Analysis of pathological types of glomerular diseases in adults

目的 了解成人肾小球疾病的病理类型及其特点。方法 分析我院145例成人肾 小球疾病患者的年龄性别分布、肾病理类型及其与临床表现的关系。结果 145例患者中,原发性 肾小球疾病占72.4%,男/女为1/1.1;继发性肾小球疾病占22.8%,男/女为1/1.54;遗传性肾小球 疾病占4.8%,男/女为2.5/1。原发性肾小球疾病病理类型以IgA肾病(IgAN)为主,占43.9%,膜 性肾病(MN)占17.1%,微小病变(MCD)占17.1%,系膜增生性肾小球肾炎(MsPGN)占15.2%, 毛细血管内增生性肾小球肾炎(EnPGN)占3.8%,膜增生性肾小球肾炎(MPGN)占1.0%,局灶节 段性肾小球硬化(FSGS)占1.0%。继发性肾小球肾炎中以狼疮性肾炎(LN)为主,占27.3%,乙型 肝炎相关性肾炎占21.2%,过敏性紫癜肾炎占18.2%,系统性血管炎占18.2%,肾淀粉样变占 6.0%,流行性出血热占3.0%,多发性骨髓瘤占3.0%,糖尿病肾病(DN)占3.0%。临床表现蛋白 尿和(或)血尿占34.0%,肾病综合征占47.3%,急性肾衰竭占10.7%,急性肾炎综合征占8.0%。 结论 原发性肾小球疾病是成人最常见的肾小球疾病,以IgAN为主。高发年龄虽在青壮年,但不 应忽视老年发病。继发性肾小球疾病中以LN多见,女性多发,其它继发性肾小球疾病逐渐增多。

Objective To survey features and pathological types of glomerular diseases in adults.Methods Distribution of age and sex,glomerular pathological types and relationship with clinical features were analyzed in 145 adult patients.Results Primary glomerular diseases accounted for 72.4%,the ratio of male to female was 1/1.1,the mean age was 35.8±12.2yr.Secondary glomerular diseases accounted for 22.8%,the ratio of male to female was 1/1.54,the age was 45.7±10.1yr.Hereditary glomerular diseases accounted for 4.8%,the ratio of male to female was 2.5/1,the age was 39.4±8.2yr.In primary glomerular diseases,IgA nephropathy (IgAN),membrane nephropathy,minimal change disease,mesangial proliferative glomerulonephritis,endocapillary proliferative glomerulonephritis,membrane proliferative glomerulonephritis,and focal segmental glomerulosclerosis accounted for 43.9%,17.1%,17.1%,15.2%,3.8%,1.0% and 1.0%,respectively. In secondary glomerular diseases,lupus nephritis (LN),HBV-associated nephritis,Henoch-Sch?nlein purpura nephritis,systemic vasculitis,amyloidosis,diabetic nephropathy hemorrhagic fever and multiple myeloma accounted for 27.3%,21.2%,18.2%,18.2%,6.0%,3.0%,3.0% and 3.0%,respectively.Clinical features included proteinuria and/or hematuria (34.0%),nephrotic syndrome (47.3%),acute renal failure (10.7%),and acute nephritic syndrome (8.0%).Conclusions Primary glomerular disease was the most common renal disease occurred in adults.IgAN was predominant.The adolescent was in high risk for primary glomerular disease.LN was the most common in secondary glomerular diseases.Female was predominant. An increment of percentage was found in other secondary glomerular diseases.