江苏部分地区805例肾活检临床病理资料分析

Analysis on clinical pathological data of 805 cases undergoing renal biopsy in part of Jiangsu province

目的:了解江苏部分地区近年来肾活检资料的流行病学特点及病理类型与临床表现之间的关系。方法:回顾性分析2003年10月至2008年9月东南大学附属中大医院肾内科来自江苏省中北部地区肾活检的临床病理资料805例,观察患者年龄、性别、病理类型,并探讨临床特征与病理类型的联系。结果:本组患者行肾活检时的平均年龄为[(36.12±14.08)(9～76)]岁,15～44岁青壮年占70.56%;男407例,女398例,男女比为1.02∶1。805例肾活检资料中肾小球肾炎(GN)占98.39%(792/805),小管间质性疾病(TID)占1.61%(13/805)。在GN中,原发性肾小球肾炎(PGN)最多,占82.32%(652/792),其余依次为继发性肾小球肾炎(SGN)(15.91%,126/792)及遗传性肾炎(HERN)(1.77%,14/792)。PGN中,IgA肾病(IgAN)所占比例最高,为43.25%(282/652),局灶节段性肾小球硬化症(FSGS)占7.98%(52/652)。SGN中狼疮性肾炎(LN)居首位,占34.92%(44/126)。Alport综合征在HERN中最为常见,占所有肾活检病例的1.61%(13/805)。最常见的临床表现是肾炎综合征(45.84%,369/805)和肾病综合征(NS)(35.90%,289/805)。IgAN是肾炎综合征最常见的病理类型,分别占急性肾炎综合征和慢性肾炎综合征的29.41%(20/68)和45.49%(131/288)。NS的病理类型主要为微小病变性肾病(MCD),占20.07%(58/289)。FSGS主要临床表现为NS(73.08%,38/52)。结论:青壮年是GN的高发人群;PGN是肾穿刺所检出的最常见肾脏疾病;IgAN在PNG中占绝大多数,是肾炎综合征最常见的原因;SGN中以LN居多,女性多发;NS最常见的病理类型是MCD;HERN以Alport综合征为主。

Objective：To survey the epidemiology,pathological category and clinical manifestation of renal diseases in part of Jiangsu province and to investigate the interrelationship between clinical features and pathological category.Methods：The clinicopathological data of 805 cases undergoing renal biopsy were obtained.The patients came from part of Jiangsu province from October 2003 to September 2008.The distribution of sex and age of all the cases,the distribution of pathological category,the interrelationship between clinical features and pathological category were analyzed.Results：The mean age of the patients was（36.12±14.08） years old（ranging 9～76 years old）,and patients aged in 15～44 amounted to 70.56%.There were 407 males and 398 females,and the ratio of male to female was 1.02 ∶1.In the 805 cases,glomerulonephritis（GN） accounted for 98.39%（792/805）,while tubular-interstitial disease（TID） was only 1.61%（13/805）.Among GN patients,primary glomerulonephritis（PGN） was of the most frequent type（82.32%,652/792）,followed by secondary glomerulonephritis（SGN）（15.91%,126/792）and hereditary nephritis（HERN）（1.77%,14/792）.Among all the categories of PGN,IgA nephropathy（IgAN）,accounting for 43.25%（282/652）was the most common type,while focal segmental glomerulosclerosis（FSGS） accounted for 7.98%（52/652）.The most prevalent cause of SGN was lupus nephritis（LN）（34.92%,44/126）.Alport syndrome was the most frequent type of HERN,and it accounted for 1.61%（13/805） in the total cases.The most common clinical manifestations were nephritic syndrome（45.84%,369/805）and nephrotic syndrome（NS）（35.90%,289/805）.IgAN was the most frequent diagnosis in those showed as acute nephritic syndrome（29.41%,20/68） and chronic nephritic syndrome（45.49%,131/288）.The most common finding course of nephrotic syndrome was MCD（20.07%,58/289）.The most common clinical manifestation of FSGS was NS（73.08%,38/52）.Conclusion：Adolescent is predominant in this group of patients.PGN is the most important and prevalent renal disease in renal biopsy.IgAN is the most common type of PGN,and it is the most frequent diagnosis in those showed as nephritic syndrome.LN is the most common type of SGN,and it frequently occurre on females.The most common finding course of nephrotic syndrome is MCD.Alport syndrome is the most frequent type of HERN.