阳泉市成人原发性肾小球疾病病理类型13年对比分析

Temporalevolution of pathological types of primary glomerular disease in Yangquan adults during 13 years

目的探讨山西省阳泉市成人原发性肾小球疾病(PGD),包括原发性肾病综合征(PNS)病理类型分布的流行病学特征。方法回顾性分析我院肾内科2011年10月至2017年10月经肾活检诊断的成人(≥18岁)PGD患者212例的流行病学特点,并与2004年9月至2011年9月我院肾活检诊断的174例PGD作比较。结果①2011年10月至2017年10月间肾活检诊断PGD共212例,男女比例为1∶1.3。PGD以膜性肾病(MN)最多,占58.5%。MN在青年组、中年组和老年组均最常见,分别为32.6%,63.2%和68.4%。②与2004年9月至2011年9月肾活检病例比较,2011年10月至2017年10月PGD中最显著的改变是MN的比率明显提高(从27.6%提高到58.5%),并超越IgA肾病(IgAN)成为成人PDG发病率最高的病理类型。163例PNS以MN最常见,占72.4%,其发病率较2004年9月至2011年9月MN的发病率明显提高(从38.0%提高到72.4%)。结论近6年来PGD中MN的比率有明显上升趋势,并超越IgAN成为发病率最高的病理类型。MN也是成人PNS最常见的病理类型。在前后两个时期肾活检指征基本未变的情况下,肾活检PGD构成比的演变可能与实际发病率的改变有关。

Objective To investigate the epidemiological characteristics in the distribution of pathological types of primary glomerular disease(PGD),including primary nephrotic syndrome(PNS),in adults of Yangquan,Shanxi Province.Methods A retrospective analysis was performed on the epidemiological characteristics of 212 adult PGDcases(aged 18 years old or above)diagnosed by renal biopsy between October 2011 and October 2017 in the Department of Nephrology of our hospital,with comparison to data from another 174 biopsy-confirmed PGD cases obtained between September 2004 and September 2011.Results①A total of 212 cases of PGD were diagnosed by renal biopsy between October 2011 and October 2017,with a male-to-female ratio of 1∶1.3.Membranous nephropathy(MN)was the most common type of PGD,accounting for 58.5%of all cases.MN was also the most common type of PGD in the young,middle-aged,and elderly groups,accounting for 32.6%,63.2%,and 68.4%of the group members,respectively.②Compared with renal biopsy findings between September 2004 and September 2011,the most significant change in PGD between October 2011 and October 2017 was a significant increase in the proportion of MN cases(from 27.6%to 58.5%)surpassing the proportion of IgA nephropathy to become the predominating pathological type among adult PDG.Among 163 cases of PNS,MN was the most common cause,accounting for 72.4%of all cases.The proportion of MN-related PNS in this period was significantly higher than that between September 2004 and September 2011(38.0%).Conclusion The proportion of MN in PGD has increased significantly in the past 6 years,and surpassed IgAN as the predominating pathological type.MN is also the most common pathological type of adult PNS.In light of the basically unchanged indications for renal biopsyacross the two periods,the evolution of the biopsy-confirmed PGD spectrum may be related to the changing PGD incidence in the real world.