经皮肾活检在肾脏疾病诊断中的应用

The Diagnostic Advantage of Percutaneous Renal Biopsy in Renal Diseases

目的回顾性分析455例肾穿刺患者临床与病理分型之间的关系。方法使用国产Menghini负压吸引穿刺针和美国产Tru-Core自动穿刺枪,在B超引导下行经皮肾穿刺活检,肾组织行光镜、免疫荧光及电镜检查。结果临床分型:455例肾穿刺患者,其中慢性肾小球肾炎169例(37.14%),肾病综合征146例(32.09%),系统性红斑狼疮54例(11.87%),急进性肾炎6例(1.31%),血尿待查7例(1.53%),糖尿病12例(2.63%),过敏性紫癜8例(1.76%),慢性肾功能不全22例(4.83%),急性肾衰31例(6.81%)。病理结果:IgA肾病(IgAN)205例(45.05%),系膜增生性肾炎(MsPGN)53例(11.65%),膜性肾病(MN)15例(3.30%),局灶节段性肾小球硬化(FsGs)9例(1.98%),膜增生性肾炎(MPGN)17例(3.73%),狼疮性肾炎(LN)58例(12.74%),紫癜性肾炎(HSPN)8例(1.76%),糖尿病肾病(DN)14例(3.07%),微小病变(MCD)16例(3.52%),硬化性肾炎20例(4.39%),急性肾小管坏死25例(5.49%),新月体肾炎6例(1.31%),慢性间质性肾炎2例(0.44%),原发性淀粉样变性3例(0.66%),ANCA相关性血管炎4例(0.88%)。结论经皮肾穿刺是一种安全、可靠的肾脏疾病诊断方法。

Objective To review and study the relationship between clinic and pathological results in 455 patients with nephropath. Methods Percutaneous renal biopsy was conducted by the B type ultrasonic detector. Every patient was punctured two times. The nephro-tissue was examined by common, immuno and electromicroscope. Results Clinical analysis was made in 169 patients with glomerulonephritis（ 37.14 % ）, 146 patients with nephrotic syndrome（32.09 % ）, 54 patients with SLE （11.87%）, 31 patients with acute renal failure （6.81%）, 22 patients with chronic renal failure （4.83 % ）, and 12 patients with DM（2.63 % ）. Pathological results demonstrated 205 patients with IgA nephropathy （45.05 % ）, 58 patients with SLE （ 12.74 % ）, 53 patients with MsPGN （ 11.65 % ）, 25 patients with acute necrosis of nephrotube （5.49 % ）, 20 patients with sclerotic nephritis （4.39 % ）, 16 patients with microdisease （3.52 % ）, 15 patients with membranous nephropathy（3.30 % ）, 14 patients with DN （3.07 % ）, 9 patients with focal segmental glomerulosclerosis（ 1.98 % ）. Conclusion percutaneous renal puncture is a safe accurate diagnostic method.