5000例肾脏疾病患者肾组织活检临床病理资料分析

Analysis on Clinical Pathological Data of 5000 Cases Undergoing Renal Biopsy in a Hospital in Xi'an

目的明确因肾脏疾病行经皮肾组织活检患者的病理分型构成及其与临床分型的关系。方法参照WHO(1982年及1995年)肾小球疾病组织学分型修订方案以及2001年我国的肾脏病理诊断标准修正方案,回顾性分析1981年1月—2007年3月的5 000例肾活检患者的临床资料、实验室检查结果、免疫病理及超微病理的改变特点,最后与临床医师共同探讨明确诊断,总结5 000例肾活检患者的病理结果。结果患者行肾活检时年龄为4～86岁,平均年龄为(35.5±11.4)岁,男女之比为1.95∶1。原发性肾小球疾病是最常见的肾脏疾病(77.40%),其病理类型中最多见者为系膜增生性肾小球肾炎(42.14%),其次为IgA肾病(26.18%)。继发性肾小球疾病占肾脏疾病的19.44%,其病理类型中最多见者为狼疮性肾炎(33.74%),其次为紫癜性肾炎(32.20%),再次为乙肝病毒相关性肾炎(8.02%)。结论本分析资料显示肾脏疾病多见于青壮年男性,以原发性肾小球疾病最常见,其中系膜增生性肾小球肾炎是最常见的病理类型,其次为IgA肾病。继发性肾小球疾病以狼疮性肾炎和紫癜性肾炎多见。

Objective To understand the constitution of pathological types and its relation with clinical types in kidney disease patients taken percutaneous renal biopsy. Methods The 5 000 cases of renal biopsy from patients with kidney disease during January 1981 and March 2007 in a hospital in Xi＇an were selected. Pathological classifications were made according to the WHO criteria of 1982 for renal pathology, the modified WHO criteria of 1995 and the modified China criteria of 2001, their clinical data, laboratory results, innnunopathological and uhrastructural pathological results were diagnosed and analyzed by a panel of pathologists and nephrologists. Results The mean age of patients at renal biopsy was 35.5± 11.4 （4-86） years and the ratio of male to female was 1.95：1. Primary glomerular diseases accounted for 77.40% of the total renal biopsies, secondary glomerular diseases accounted for 19.44%. Mesangial proliferative lesion （42.14%） was the most frequent patholigic type of primary glomerular diseases, followed by IgA nephropathy （26.18%）.The most frequent type of secondary glomerular diseases was lupus nephritis （33.74%）, followed by Henoeh-Sehonlein purpura glomerulonephritis （32.20%） and hepatitis B virus associated nephritis （7.86%）. Conclusion Our dates show that renal diseases in this hospital often happened in young men. Primary glomerular disease is the most common renal glomerular disease and mesangial proliferative lesion is the most common histological types, followed by lgA nephropathy. Lupus nephritis, followed by henoch-Schonlein purpura glomerulonephritis, are the most common types of the Secondary glomerular diseases.