431例肾活检病理类型及流行病学特点

Pathological patterns and epidemiological characters of 431 cases of renal biopsy

目的通过对浙江省衢州市431例肾病患者的肾活检病理资料进行总结分析,并探讨其在衢州市的分布情况,以推测其流行病学的地方特点。方法回顾性分析我院2012年1月~2014年12月期间收治的431例肾病患者的流行病学特点,并分析其病理类型的分布情况及流行病学特点。结果成功穿刺431例肾标本,其中男181例（42.0%）,女250例（58.0%）,男/女=1∶1.38。从疾病临床分型看,肾病综合征（NS）最多为178例（41.3%）,第2位是慢性肾小球肾炎（CGN）为l42例（32.9%）。从病因分类看431例患者中原发性肾小球肾炎（PGN）最多为342例（79.3%）,继发性肾小球肾炎（SGN）77例（17.9%）,小管-间质疾病（TID）11例（2.6%）,移植肾疾病1例（0.2%）。原发性肾小球炎（PGN）中Ig A肾病（Ig AN）和膜性肾病（MN）所占比例较高,分别占32.7%和24.5%。继发性肾小球肾炎（SGN）中狼疮性肾炎（LN）占比最高,为40.2%;过敏性紫癜性肾炎（HSPGN）为18.2%,乙型肝炎病毒相关性肾炎（HBVGN）占13.0%。结论 PGN是肾穿刺活检中最常见的病因,其中大多数属Ig AN和MN;SGN中LN最多见,HSPGN及HBVGN也较多。在本地区肾病防治工作中,青壮年发病率较高,需重点关注Ig AN和MN,还有LN。

Objective To summarize and analyze the pathological data of 431 cases of renal biopsy from Quzhou, Zhejiang and to discuss the epidemiological characters via pathological distribution in Quzhou. Methods A total of 431 patients with kidney diseases hospitalized between January 2012 and December 2014 by our hospital were reviewed and their epidemiological characters and distribution of pathological patterns were analyzed. Results Among the 431 specimens, 181 cases were from males（42.0%）, and 250 were females（58.0%, male/female=1∶1.38）. As to the clinical types of disease, the most common disease was nephrotic syndrome（NS, 178 cases, 41.3%）, followed by chronic glomerulonephritis（CGN, 142 cases, 32.9%）. As to the etiologic classification, a majority of 342 cases were primary glomerulonephritis（PGN, 79.3%）, 77 cases were secondary glomerulonephritis（SGN, 17.9%）, 11 cases were tubulo-interstitial disease（TID, 2.6%）, and 1 case was renal transplantation disease（0.2%）. Among the PGN patients, Ig A nephropathy（Ig AN） and membranous nephropathy（MN） were most commonly observed, accounting for 32.7% and 24.5%, respectively.Of the SGN patients, lupus nephritis（LN） was most common, accounting for 40.2%, which was followed by HenochSchonlein purpura nephritis（HSPGN, 18.2%） and hepatitis b virus-associated glomerulonephritis（HBVGN, 13.0%）.Conclusion PGN is the most common etiological factor of kidney biopsy, with Ig AN and MN at most. LN is the main type of SGN, followed by HSPGN and HBVGN. In Quzhou, Zhejiang, the incidence rate is higher in young adults, indicating that special attention should be paid on Ig AN, MN and LN in prevention and treatment of kidney diseases.