新疆维吾尔自治区1986—2020年单中心5652例成人肾活检病理谱及其演变特征

Single-center retrospective analysis of pathological spectrum and variation of 5652 adult renal biopsies in Xinjiang Uygur Autonomous Region from 1986 to 2020

目的研究新疆维吾尔自治区人民医院1986—2020年成人肾活检病理谱特征及其演变情况。方法回顾性收集新疆维吾尔自治区人民医院1986年8月至2020年12月5652例成人肾活检病理资料,分析肾活检病理谱分布特征。按每5年时间为1个研究阶段,将本研究分为7个阶段进行病理类型分布及变化趋势分析,即P1期:1986年8月至1990年12月;P2期:1991年1月至1995年12月;P3期:1996年1月至2000年12月;P4期:2001年1月至2005年12月;P5期:2006年1月至2010年12月;P6期:2011年1月至2015年12月;P7期:2016年1月至2020年12月。结果在5652例肾活检病例中,年龄(36.47±14.86)岁(18~83岁),男性2961例(52.39%);其中成人自体肾活检5636例,移植肾活检16例。自体肾活检病例按疾病类型分类排列顺序为:原发性肾小球疾病[4470例(79.31%)]、继发性肾小球疾病[994例(17.64%)]、肾小管间质疾病[160例(2.84%)]、遗传性肾病[12例(0.21%)]。原发性肾小球疾病排名前5种病理类型依次为:IgA肾病[1573例(35.19%)]、膜性肾病[1028例(23.00%)]、系膜增生性肾小球肾炎[878例(19.64%)]、微小病变型肾病[427例(9.55%)]和局灶节段性肾小球硬化症[345例(7.72%)]。继发性肾小球疾病排名前5种病理类型依次为:狼疮肾炎[251例(25.25%)]、高血压肾损害[193例(19.42%)]、糖尿病肾脏疾病[168例(16.90%)]、紫癜性肾炎[138例(13.88%)]和缺血性肾病[90例(9.05%)]。原发性肾小球疾病中以IgA肾病最常见,其高发年龄段为18~59岁。汉族、维吾尔族和其他民族均以原发性肾小球疾病为主要病因,分别占78.33%、81.72%和77.15%,维吾尔族原发性肾小球疾病发生率高于汉族(采用Bonferroni校正法,P<0.017)。P1期至P7期,原发性肾小球疾病常见病理类型中,膜性肾病和微小病变型肾病的构成比均上升,系膜增生性肾小球肾炎构成比则大幅下降(均P<0.05)。P5期至P7期,原发性肾小球疾病常见病理类型中,汉族和维吾尔族患者中膜性肾病构成比均大幅上升,系膜增生性肾小球肾炎构成比则下降(均P<0.05)。继发性肾小球疾病中,狼疮肾炎构成比为首位,且女性构成比远高于男性(P<0.001);维吾尔族继发性肾小球疾病发生率低于汉族(采用Bonferroni校正法,P<0.017)。从P5至P7期,汉族和维吾尔族继发性肾小球疾病常见病理类型未见明显变化。移植肾活检病理类型以慢性排斥反应为主。结论新疆维吾尔自治区人民医院肾脏疾病谱以原发性肾小球疾病为主,其中IgA肾病最常见,其高发年龄段为18~59岁。随时间推移,膜性肾病和微小病变型肾病构成比升高,系膜增生性肾小球肾炎构成比明显降低。狼疮肾炎是最常见的继发性肾小球疾病。

Objective To investigate the pathological spectrum and variation of adult renal biopsies in People's Hospital of Xinjiang Uygur Autonomous Region from 1986 to 2020.Methods The pathological data of 5652 adult renal biopsies from August 1986 to December 2020 were retrospectively collected,and characteristics of pathological spectrum were analyzed.Regarding every 5 years as a research stage,the whole period was divided into 7 stages to analyze the pathological features and variation of renal biopsies.The first stage(P1)started from August 1986 to December 1990.The second stage(P2)started from January 1991 to December 1995.The third stage(P3)started from January 1996 to December 2000.The fourth stage(P4)started from January 2001 to December 2005.The fifth stage(P5)started from January 2006 to December 2010.The sixth stage(P6)started from January 2011 to December 2015.The seventh stage(P7)started from January 2016 to December 2020.Results The age was(36.47±14.86)years old(18-83 years old)in 5652 renal biopsies.There were 2961 males(52.39%).There were 5636 cases of autologous kidney biopsy and 16 cases of transplanted kidney biopsy.The descending order of incidence classified by disease types were primary glomerular disease(PGD,4470 cases,79.31%),secondary glomerular disease(SGD,994 cases,17.64%),tubular-interstitial disease(160 cases,2.84%),and hereditary nephropathy(12 cases,0.21%).IgA nephropathy(IgAN,1573 cases,35.19%)was the most frequent pathologic type of PGD,followed by membranous nephropathy(MN,1028 cases,23.00%),mesangial proliferative glomerulonephritis(MsPGN,878 cases,19.64%),minimal change disease(MCD,427 cases,9.55%),and focal segmental glomerulosclerosis(345 cases,7.72%).Lupus nephritis(LN,251 cases,25.25%)was the most common type of SGD,followed by hypertension nephropathy(193 cases,19.42%),diabetic kidney disease(168 cases,16.90%),purpura nephritis(138 cases,13.88%),and ischemic nephropathy(90 cases,9.05%).IgAN was the most common type of primary glomerulonephritis and mainly occurred in the age group of 18-59 years old.PGD was the most common glomerular disease in Han nationality(78.33%),Uygur nationality(81.72%)and other ethnic(77.15%)groups.Using Bonferroni correction method,the incidence of PGD in Uygur nationality was higher than that in Han nationality(P<0.017).From P1 to P7,the detection rates of MN and MCD were increased in common renal pathological types,meanwhile,the ratio of MsPGN was decreased(all P<0.05).From P5 to P7,the detection rates of MN in Han nationality and Uygur nationality increased in the common pathological types of PGD,meanwhile,the ratio of MsPGN decreased(all P<0.05).LN was the most common SGD.The incidence of LN in females was higher than that in males(P<0.001).Using Bonferroni correction method,the incidence of SGD in Uygur nationality was lower than that in Han nationality(P<0.017).There was no significant variation in the common pathological type of SGD in Han and Uygur nationalities.Chronic rejection was the main pathological type of transplanted kidney biopsies.Conclusions PGD is the main type of kidney disease spectrum in People's Hospital of Xinjiang Uygur Autonomous Region.IgAN is the most common PGD and mainly occurrs in the age group of 18-59 years old.As time goes by,the proportion of MN and MCD is increased,meanwhile the proportion of MsPGN is decreased significantly.LN is the most common SGD.