462例肾活检患者病理及临床资料回顾性分析

Retrospective analysis of pathology and clinical data of 462 cases receiving renal biopsy

目的 探讨黑龙江省地区肾小球疾病的流行病学特点及疾病谱的变化,为肾小球疾病的预防及治疗提供理论依据.方法 选取2010年1月至2016年10月于哈尔滨医科大学附属第一医院肾内二科住院并行肾穿刺活检、临床病理资料完整的462例CKD患者进行回顾性分析.结果 ①462例肾穿刺活检患者中,原发性肾小球疾病（PGD） 366例（79.22％）,继发性肾小球疾病（SGD） 92例（19.91％）,肾小管间质疾病（TID）3例（0.65％）,遗传性肾病1例（0.22％）.PGD中以膜性肾病为主（49.73％）,其次为IgA肾病（25.96％）、微小病变型肾病（6.28％）等;SGD中最常见的为狼疮性肾炎（lupus nephrieis,LN） （37.00％）,其次为过敏性紫癜性肾炎（17.39％）、乙型肝炎病毒相关性肾炎（hepatitis B virus associated nephritis,HBVGN）（15.22％）等;②PGD以男性好发（85.71％）,而SGD则多发于女性（27.18％）.PGD中男性膜性肾病的构成比（61.76％）高于女性（39.16％）,女性IgA肾病的构成比（35.66％）高于男性（21.57％）.SGD中LN以女性好发（66.67％）,HBVGN以男性好发（33.33％）;③不同性别患者肾穿刺指征比较,差异有统计学意义（P〈0.05）,但均以肾病综合征、肾炎综合征、无症状的血尿和/或蛋白尿最常见,仅所占比例有所不同;④PGD和SGD年龄分布比较,差异无统计学意义（P〉0.05）.结论 肾活检患者中最常见的为PGD,PGD中又以膜性肾病最为多见,其次为IgA肾病.近年来,膜性肾病的发病率显著升高.

Objective To investigate the epidemiological characteristics and pathological changes of glomerular diseases in Heilongjiang province,and to provide theoretical basis for the prevention and treatment of glomerular diseases.Methods A total of 462 patients with chronic kidney diseases（CKD） who underwent percutaneous renal biopsy in our hospital from January 2010 to October 2016,were selected as study subjects,their clinical and pathological data were analyzed retrospectively.Results ①Of the 462 cases of renal biopsy,366 cases （79.22%） had primary glomerular disease （PGD）,92 cases （19.91%） were secondary glomerular disease （SGD）,and renal tubulointerstitial diseases （TID） in 3 cases （0.65%）,hereditary nephropathy in 1 case （0.22%）.PGD was mainly membranous nephropathy （49.73%）,followed by IgA nephropathy （25.96%）,minimal change nephropathy （6.28%） and so on.② PGD was predisposed to males （85.71%）,while SGD was mostly female （27.18%）.The proportion of male membranous nephropathy in PGD was higher than that in female （39.16%）,and that in female IgA nephropathy （35.66%） was higher than that in male （21.57%）.Lupus nephritis（LN） was predisposed to female in SGD （66.67%）,hepatitis B virus associated glomerolunephritis （HBVGN） predominantly in male （33.33%）.③There were significant differences in renal biopsy between different sexes（P 〈0.05）,but nephrotic syndrome,nephritis syndrome,asymptomatic hematuria and / or proteinuria were the most common （P 〈 0.05）.④There was no significant difference in PGD and SGD age distribution （P 〉 0.05）.Conclusions The most common for the PGD,and membranous nephropathy in PGD is the most common,followed by IgA nephropathy in renal biopsy.In recent years,the incidence of membranous nephropathy has increased significantly.