2444例肾活检临床病理分析

Clinical and Pathologic Patterns Based on 2444 Native Kidney Biopsies

目的：分析近5年2 444例肾活检患者肾脏疾病构成比及不同年龄段肾脏疾病构成比变化的特点。方法：回顾分析2005年1月—2009年12月2 444例肾活检患者肾脏疾病的构成比及每年肾脏疾病构成比的变化,并根据年龄分为4个年龄段,分析每个年龄段患者肾脏疾病构成比的特点。结果：原发性肾小球疾病仍为目前最主要的肾脏疾病（占79.58%）,其每年所占比例无明显改变。IgA肾病是最常见的原发性肾小球疾病,占47.97%。局灶节段增生性肾炎每年所占的比例不一（P〈0.01）,系膜增生性肾炎比例逐年减少（P〈0.001）,膜性肾病比例有升高趋势,但差异无统计学意义（P〉0.05）。继发性肾脏疾病中,糖尿病肾病、高血压肾损害逐年增高（P均〈0.01）。不同年龄段患者无论是原发性肾小球疾病还是继发性肾脏疾病的构成比都有显著差异（P=0.000）。97.0%的IgA肾病患者年龄位于18~45岁,微小病变好发于18岁以下,而65岁以上患者最常见膜性肾病（33.59%）。18岁以下患者最常见的继发性肾脏疾病为紫癜性肾炎（64.29%）,中青年患者最常见的继发性肾脏疾病是狼疮性肾炎（65.42%）。结论：肾脏疾病构成比逐年变化,不同年龄患者肾脏疾病构成比各有特点。

Objective：To analyze the pathologic patterns of native kidney biopsies based on a five-year overview and to identify the age-specific pathologic features.Methods： Retrospectively review the reports of 2444 native kidney biopsies whose renal biopsies were performed in Zhongshan Hospital,Fudan University,from Jan 2005 to Dec 2009.Patients were divided into 4 groups according to age,and the pathologic entities based on age distribution were analyzed.Results： Primary glomerulonephritis remained the most common（79.58%） pathologic pattern in our unit.IgA nephritis,holding a 47.97 percentage,was the most common type of primary glumerulonephritis,which kept a steady incidence,but the yearly incidence of focal segmental glomerulonephrotis varied a lot.The prevalence of mesangial proliferative glomerulonephritis decreased every year（P0.001）.While membranous nephropathy were presented with an increase tendency.As for secondary kidney diseases,diabetic nephropathy and hypertensive nephropathy occurred more frequently year after year（All P0.001）.There was an age-specific impact on the constitution of histopathology types.97% patients of IgAN aged between 18～45 years old.minimal changes diseases were prevalent in patients under 18 years old.Membraneous nephropathies（33.59%） were most frequent primary glomerulonephnt is over 65 years old.Of patients under 18 years old,the most frequent secondary kidney disease was Henoch-Schonlein Purpura Nephritis.Lupus nephritis was responsible for most cases which etiology was determined（65.42%） in young and middle-aged adults.Conclusions： The constituent ratio of histopathology types varie yearly with age specific characteristics.