914例肾活检临床与病理资料分析

Relation between Clinical Presentation and Pathological Classification of 914 Cases of Renal Biopsy

目的分析潍坊市周边12县市区肾脏疾病病理类型分布的流行病学特点及疾病谱的演变。方法回顾性分析2008年3月-2016年6月在潍坊市人民医院行肾穿刺活检的914例患者的住院资料,对其年龄、性别、籍贯、临床表现、病理类型等因素进行流行病学调查。结果纳入研究的患者肾活检年龄12-78（39.8±18.5）岁,其中男性508例（55.6%）、女性406例（44.4%）,以农村和城乡结合部居民为主,共694例（75.9%）。研究中原发性肾小球病（PGN）718例（78.6%）,继发性肾小球病（SGN）135例（18.8%）,肾小管间质性肾病（TID）55例（6.0%）,遗传性肾病6例（0.7%）。不同性别、年龄与各病理分类间有统计学意义（P〈0.05）。PGN中男性发病率57.2%,其中特发性膜性肾病（43.9%）和Ig A肾病（32.0%）是最常见的病理类型,其次为微小病变性肾小球肾炎（9.3%）、局灶节段性肾小球硬化（6.3%）、系膜增生性肾小球肾炎（3.6%）、膜增殖性肾病（1.4%）,其中不同性别、年龄与PGN各病理类型之间有统计学意义（P〈0.05）。SGN中女性发病率58.5%,以狼疮性肾炎（LN）为主（31.1%）,其中女性LN患者占81.0%,其次为乙肝相关性肾病（17.8%）和过敏性紫癜性肾炎（11.1%）。不同性别与SGN常见病理类型间差异有统计学意义（P〈0.05）,而不同年龄与SGN常见病理类型间无统计学意义（P〉0.05）。肾小管间质性疾病可见于各年龄段,男性多发（70.9%）,多表现为急性或慢性肾功能不全。肾穿刺临床指征以肾病综合征为主,共523例（57.2%）,肾炎综合征193例（21.1%）,无症状尿检异常86例（9.4%）,单纯肉眼血尿23例（2.5%）,肾功能不全89例（9.7%）。不同年龄与肾穿刺指征间差异有统计学意义（P〈0.05）。结论潍坊地区农村和城乡结合部居民是本地就诊的主要人群,肾病综合征为肾活检的主要临床指征。病理表现以原发性肾小球病为主,其中特发性膜性肾病和Ig A肾病发病率最高,而且特发性膜性肾病在本地区所占肾穿刺比例有逐年升高趋势。更年期前后原发性肾小球病呈明显高发趋势,以特发性膜性肾病发病显著。

Objective To analyze the features of renal biopsy and the relation between clinical manifestation and pathological types in weifang. Methods There was a retrospective analysis from March 2008 to June 2016 in weifang people＇s hospital about data of 914 cases of renal biopsy patients,epidemiological survey was conducted on the age,gender,origin,clinical manifestation,pathological type and other factors. Results The mean age of renal biopsy patients was 39. 8 ± 18. 5（ 12 - 78） years in 508 male cases（ 55. 6%） and 406 female cases（ 44. 4%）,and most people in rural and semi-urban areas（ 694 cases,75. 9%）. In this study,the primary glomerular nephritis（ PGN）was 718 cases（ 78. 6%）,the secondary glomerular nephritis（ SGN） 135 cases（ 18. 8%）,the tubular interstitial disease（ TID） 55 cases（ 6.0%）,and the hereditary kidney disease 6 cases（ 0. 7%）. There were significant differences in constituent of renal pathological classificationin different gender and ages（ P〈0. 05）. Among PGN,the idiopathic membranous nephropathy（ 43. 9%） and the IgA nephropathy（ 32. 0%）were the most common two pathological types,followed by minimal change glomerulonephropathy（ 9. 3%）,focal segmental glomerulosclerosis（ 6. 3%）,mesangial proliferative glomerulonephritis（ 3. 6%）,membranoproliferative glomerulonephritis（ 1. 4%）. There were significant differences in constituent of pathological type of PGN in different gender and ages（ P〈0. 05）. Among SGN,lupus nephritis was the most common pathological type（ 42 cases,31. 1%）,which included 34 female cases（ 81. 0%）,followed by HBV-associated glomerulonephritis（ 24 cases,17. 8%）,purpura nephritis（ 15 cases,11. 1%）. There were significant differences in constituent of pathological types of SGN in different gender（ P〈0. 05）,yet not in different ages（ P〉0. 05）. TID,which was always characterized by acute or chronic renal insufficiency,could be seen widely in all ages,and most male cases（ 70. 9%）. The most common clinical indication of renal biopsy was nephrotic syndrome（ 523 cases,57. 2%）,followed by nephritis syndrome（ 193 cases,21. 2%）,renal insufficiency（ 89 cases,9. 7%）,asymptomatic urinary abnormalities（ 86 cases,9. 4%）,isolated macroscopic haematuria（ 23 cases,2. 5%）. There were significant differences in constituent of renal biopsy in different ages（ P〈0. 05）. Conclusion This study indicates most cases are from rural and semi-urban area in weifang,and nephrotic syndrome is the main indication of renal biopsy. PGN is the most common pathological feature,and idiopathic membranous nephropathy（ IMN）and IgA nephropathy are the most frequent pathological types. By contrast,IMN in this region increases year by year. This study also suggests that there＇s a significant tendency for IMN to share high morbidity rates before and after menopause as the same as PGN.