十年间老年肾脏病患者肾组织穿刺活检病理特点对比分析

Pathological Characteristics of Renal Biopsy Tissue in Elderly People with Renal Disease:a Ten-year Comparative Analysis

背景老年肾脏病发病率呈逐年上升趋势,但老年肾脏病患者在临床病理类型和临床表现均有其特殊性,并且肾脏病的病理类型因不同种族、地理区域,构成差别较大,随时间的推移又有不同的演变趋势。目的了解近10年来老年肾脏病患者肾组织穿刺活检病理特点的变化。方法收集2008-2017年中国人民解放军联勤保障部队第900医院、厦门大学附属第一医院及厦门大学附属中山医院肾内科住院并行肾组织穿刺活检,年龄≥60岁的老年肾脏病患者652例。根据住院的时间分为2008-2012年284例,2013-2017年368例。对比分析老年肾脏病患者的性别、年龄、主要临床表现及病理分型。结果2008-2012年与2013-2017年老年肾脏病患者性别及年龄比较,差异均无统计学意义(P>0.05)。老年肾脏病患者最常见的临床表现为肾病综合征[45.2%(295/652)],其次为急性肾损伤[23.3%(152/652)]。2008-2012年与2013-2017年老年肾脏病患者肾病综合征、肾炎综合征、隐匿性肾炎、慢性肾衰竭发生率比较,差异均无统计学意义(P>0.05);2013-2017年老年肾脏病患者急性肾损伤发生率较2008-2012年升高(P<0.05)。2008-2012年与2013-2017年老年肾脏病患者原发性肾小球疾病及继发性肾小球疾病所占比例比较,差异有统计学意义(P<0.05)。2008-2012年与2013-2017年老年肾脏病患者原发性肾小球疾病构成比较,差异有统计学意义(P<0.05);其中2013-2017年老年肾脏病患者膜性肾病所占比例高于2008-2012年(χ^2=12.224,P<0.001)。2008-2012年与2013-2017年老年肾脏病患者继发性肾小球疾病构成比较,差异无统计学意义(P>0.05)。结论老年肾脏病患者中,肾病综合征仍为最常见的临床表现,但急性肾损伤发生率较前升高,原发性肾小球疾病仍为主要病理类型,但所占比例有所下降。老年肾脏病患者肾脏病理构成的演变可能与实际发病率的改变及诊断水平的提高有关。

Background The incidence of kidney disease in the elderly population is increasing each year.This disease in older people presents special clinical pathological types and manifestations.And its pathological types vary substantially according to race and geographical region,and also change over time.Objective To explore the pathological changes of renal biopsy tissues in elderly people with kidney disease in recent 10 years.Methods A total of 652 kidney disease inpatients aged≥60 years from Department of Nephrology,the 900th Hospital of Joint Logistic Support Force,PLA,the First Affiliated Hospital of Xiamen University,and Zhongshan Hospital,Xiamen University during 2008 to 2017 were enrolled,including 284treated between 2008 and 2012,and 368 treated between 2013 and 2017.Both groups underwent pathological examination of renal biopsy tissues,and the detected pathological types,as well as sex,age,and major clinical manifestations were analyzed comparatively.Results Both groups showed no significant differences in sex and age(P>0.05).The most common clinical manifestation in both groups was nephrotic syndrome[45.2%(295/652)],followed by acute kidney injury[23.3%(152/652)].The incidence rates of nephrotic syndrome,nephritis syndrome,occult nephritis,and chronic renal failure were similar in both groups(P>0.05).Those treated between 2013 and 2017 were found to have a much higher incidence rate of acute kidney injury(P<0.05).The percentage and types of primary glomerular diseases differed significantly between the groups(P<0.05).In particular,those treated between 2013 and 2017 were identified with a significantly higher percentage of membranous nephropathy(χ^2=12.224,P<0.001).Two groups showed significantly different percentages of secondary glomerular diseases(P<0.05),but the types of secondary glomerular diseases were similar(P>0.05).Conclusion Nephrotic syndrome is still the most common clinical manifestation in elderly patients with kidney disease,but the incidence rate of acute kidney injury is higher than before.Primary glomerular disease is still the main pathological type,but its proportion has decreased.The evolution of renal pathology in this population may be correlated with variations in actual morbidity and the improvement of diagnostic ability.