2008—2020年北京市4652例成人肾活检患者病理分析

Pathological analysis of 4652 cases of renal biopsy:a multicentral study in Beijing from 2008 to 2020

目的总结和分析北京市三家医院13年肾活检病理特点和疾病谱变迁。方法回顾分析2008—2020年北京市3家医院肾活检患者的病理资料。按照年龄分为18~40岁组、40~65岁组和≥65岁组。按照肾活检时间分为3个阶段:2008—2011年、2012—2015年和2016—2020年。分析各年龄组、各阶段肾活检的病理类型及病理谱变迁。结果共4652例患者纳入研究,原发性肾小球疾病占81.8%(3803/4652),其中,前3位分别为膜性肾病(32.4%,1509/4652)、IgA肾病(29.2%,1356/4652)和肾小球轻微病变(11.3%,526/4652)。病理谱变迁:2008—2011年间至2016—2020年间,(1)全体肾活检人群:膜性肾病和糖尿病肾病患者的比例明显上升,分别从20.3%和2.3%升至37.3%和10.1%(χ^(2)分别为99.9和96.1,均P<0.01);(2)18~40岁组:膜性肾病和糖尿病肾病患者的比例分别从11.2%和1.6%升至24.7%和5.5%(χ^(2)值分别为32.7和20.7,均P<0.01);(3)40~65岁组:膜性肾病和糖尿病肾病患者的比例分别从26.6%和3.2%升至41.5%和13.1%(χ^(2)值分别为39.1和57.3,均P<0.01);(4)≥65岁组:3个阶段最常见的病理类型均为膜性肾病,占比波动于41.3%~55.0%(χ^(2)=5.2,P=0.08)。糖尿病肾病的比例快速上升,从0(0/63)上升至7.5%(22/292)(χ^(2)=8.1,P=0.02)。结论膜性肾病和糖尿病肾病是成人肾活检最常见的原发性和继发性肾小球疾病的病理类型,且年轻化趋势明显。

Objective To analyze characteristics and trends of histopathological diagnosis of adult renal biopsy in Beijing from 2008 to 2020.Methods A total of 4652 cases of adult renal biopsy were collected from three hospitals in Beijing between 2008 and 2020.The patients were divided into three age groups:18-40 years,40-65 years and≥65 years;and also divided into three period:2008-2011,2012-2015,and 2016-2020.The pathological characteristics and changes of renal biopsy were analyzed in three age groups at different periods.Results Among 4652 cases primary glomerular disease accounted for 81.8%,the membranous nephropathy(MN,32.4%,1509/4652),IgA nephropathy(IgAN,29.2%,1356/4652)and minor glomerular abnormalities(MGA,11.3%,526/4652)were the top three pathological types.The overall proportion of MN and diabetic nephropathy(DN)increased from 20.3% and 2.3% in 2008-2011 to 37.3% and 10.1% in 2016-2020(χ^(2)=99.9 and 96.1,both P<0.01),respectively.For age group 18-40 years,the MN and DN increased from 11.2% and 1.6% in 2008-2011 to 24.7% and 5.5% in 2016-2020(χ^(2)=32.7 and 20.7,both P<0.01),respectively.For age group 40-65 years the MN and DN increased from 26.6% and 3.2% in 2008-2011 to 41.5% and 13.1% in 2016-2020(χ^(2)=39.1 and 57.3,both P<0.01),respectively.For age group≥65 years the MN was the most common pathological type in the three periods,fluctuating between 41.3% and 55.0%(χ^(2)=5.2,P=0.08);and DN increased from 0(0/63)in 2008-2011 to 7.5%(22/292)in 2016-2020(χ^(2)=8.1,P=0.02).Conclusion The renal biopsy data show that membranous nephropathy and diabetic nephropathy are the most common primary and secondary adult glomerular diseases in Beijing recently.