潍坊市肾脏疾病病理类型分布的流行病学特点及疾病谱的演变

Epidemiological Characteristics of the Distribution of Pathological Types of Kidney Diseases and the Evolvement of Disease Spectrum in Weifang

目的 分析潍坊市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月于潍坊市人民医院行肾活检的914例患者的临床及病理资料,包括就诊年龄、性别、籍贯、临床表现及病理类型等。按就诊时的年龄将患者分为4组：青少年组（12-30岁）196例、中年前期组（31-45岁）256例、更年期前后组（46-60岁）323例、老年组（〉60岁）139例。结果 纳入研究的患者中男508例（55.6%）、女406例（44.4%）;肾活检年龄12-78岁,平均年龄（39.8±18.5）岁;以农村和城乡结合部居民为主,共694例（75.9%）;原发性肾小球病（PGN）718例（78.6%）,继发性肾小球病（SGN）135例（14.8%）,肾小管间质性肾病（TID）55例（6.0%）,遗传性肾病6例（0.6%）。不同性别、年龄患者的病理类型比较,差异有统计学意义（P〈0.05）。PGN中特发性膜性肾病（43.9%）和IgA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%）。不同年龄PGN患者病理类型比较,差异有统计学意义（P〈0.05）。SGN中,以狼疮性肾炎（LN）为主（31.1%）,其次为乙肝病毒相关性肾病（17.8%）和过敏性紫癜性肾炎（11.1%）。不同年龄SGN患者病理类型比较,差异无统计学意义（P〉0.05）;不同性别SGN患者病理类型比较,差异有统计学意义（P〈0.05）。TID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%）。不同年龄患者肾穿刺指征比较,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,以肾病综合征为肾活检的主要临床指征。病理表现以PGN为主,其中特发性膜性肾病和IgA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迹象。围绝经期前后PGN发病率呈升高趋势,其中特发性膜性肾病最常见。

Objective To analyze the epidemiological characteristics of the distribution of pathological types of kidney diseases and the evolvement of disease spectrum in Weifang. Methods The clinical and pathological data of 914 patients with renal biopsy at Weifang People＇s Hospital from March 2008 to June 2016,including age, sex, place of origin, clinical manifestation and pathological type were retrospectively analyzed. According to the age of treatment, the patients were divided into youth group （12 -30 tears old,= 196）,middle - aged group （31 -45 years old,=256）,before and after menopause group （46 -60 years old, n = 323） , and old group （ 〉 60 years old, n = 139）. Results Of the patients included, 508 （55. 6% ） were male and 406 （44. 4% ） were female; the age of the renal biopsy was 12-78 years old, the average age was （39. 8 ± 18.5） years old; 694 （75.9%） were rural and urban fringe residents; PGN 718 cases （78.6%）, secondary glomerulopathy 135 cases （ 14. 8% ） , TID 55 cases （ 6. 0% ） , hereditary nephropathy 6 cases （ 0. 6% ）. There were statistically significant differences in pathological types of patients with different sex and age （P 〈 0. 05 ）. Among the PGN, idiopathic membranous nephropathy （43.9%） and IgA nephropathy （32.0%） were the most common pathologic types, followed by minimal change glomerulonephritis （9. 3% ） , focal segmental glomerulosclerosis （6. 3% ） , mesangial proliferative glomerulonephritis （3.6%）, membranoproliferative nephropathy （ 1. 4% ）. There were statistically significant differences in pathological types of PGN patients with different age （ P 〈 0. 05 ）. Among the LNN, lupus nephritis （31. 1% ） was the main case, followed by hepatitis B related nephropathy （17. 8% ） and Henoch - Schonlein purpura nephritis （11. 1% ）. There was no significant difference in pathological types of SGN patients with different age （P 〉 0. 05 ） . There were statistically significant differences in pathological types of SGN patients with different sex （P 〈 0. 05 ）. TID can be found in all ages, and was ore common in men （70. 9% ） , more than the performance of acute or chronic renal insufficiency. There were 523 cases （57. 2% ） with nephrotic syndrome, 193 cases （21. 1% ） with nephritic syndrome, 86 cases （9. 4% ） with asymptomatic urine test, 23 cases （2. 5% ） with gross hematuria, 89 cases （9. 7% ） with renal insufficiency in the indications for renal puncture. There were statistically significant differences in the indications for renal puncture of patients with different age （ P 〈 0. 05 ）.Conclusion Weifang rural and urban fringe residents is the main crowd of local treatment, with nephrotic syndrome as the main clinical indications for renal biopsy. The pathologic findings of renal disease are mainly PGN, the incidence of idiopathic membranous nephropathy and IgA nephropathy are the highest, and the proportion of idiopathic membranous nephropathy in the region is increasing year by year. Peri - menopausal PGN incidence rate was increased, and idiopathic membranous nephropathy is most common.