甘肃和青海地区226例部队患者肾脏病临床与病理分析

Clinical and pathological data analysis of kidney disease from 226 officers and soldiers in Gansu and Qinghai area

目的总结甘肃、青海地区部队官兵患者肾脏病的临床与病理特征。方法回顾性分析2016年7月至2020年6月在解放军联勤保障部队第九四〇医院住院并行肾穿刺活检官兵的临床资料和病理资料。结果4年中共226例官兵行肾穿刺活检,干部48例(21.24%),战士178例(78.76%),差异有统计学意义(P<0.01)。活检前病程中位数5.5周(3~28周),战士4.84周,干部7.11周,差异有统计学意义(P<0.01)。原发性肾病194例(85.84%),继发性肾病20例(8.85%),遗传性肾病6例(2.65%)。临床上肾小球肾炎最常见,共110例,占48.68%,其他依次为肾病综合征(NS)56例(24.78%)、孤立性血尿30例(13.27%)、肾功能不全26例(11.50%)。原发性肾病中,IgA肾病最常见,共82例,占42.27%,其他依次为系膜增生性肾小球肾炎(MsPGN)52例(26.80%)、膜性肾病(MN)26例(13.40%)、微小病变(MCD)18例(9.28%)、局灶节段性肾小球硬化(FSGS)16例(8.25%)。NS中,MN最常见,共20例,占37.0%,其他依次为MCD16例(29.6%)、MsPGN12例(22.2%)、FSGS2例(3.7%)、IgA肾病2例(3.7%)、过敏性紫癜性肾炎(HSPN)2例(3.7%)。继发性肾病中,HSPN最常见,共8例,占40.0%,其余依次为糖尿病肾病(DN)6例(30.0%)、高血压肾病3例(15.0%)、痛风性肾病2例(10.0%)、狼疮性肾炎(LN)1例(5.0%)。遗传性肾病中,薄基底膜肾病(TBMN)最常见,共5例,占83.3%。结论甘肃、青海地区部队患者肾穿刺活检病因主要为原发性肾病,继发性肾病发病率远低于普通人群,遗传性肾病不罕见。原发性肾病主要病理类型为IgA肾病与MsPGN,继发性肾病以HSPN、DN多见,遗传性肾病多为TBMN。

Objective To summarize the clinical and pathological data characteristics of officers and soldiers who undergoing renal biopsy in Gansu and Qinghai area.Methods A retrospective analysis was done about the officers and soldiers whom hospitalized with renal biopsy in our hospital from July 2016 to June 2020,and collected whose clinical data and pathological data.Results A total of 226 officers and soldiers underwent renal biopsy in 4 years.There were 48 officers(21.24%),178 soldiers(78.76%)(P<0.01).The median duration of disease before biopsy was 5.5 weeks(3-28 weeks),soldiers vs officers are 4.84 vs 7.11 weeks(P<0.01).There were 194 cases of primary nephropathy(85.84%),20 cases(8.85%)of secondary nephropathy,and 6 cases(2.65%)of hereditary nephropathy.Glomerulonephritis is the most common clinically,with 110 cases,accounting for 48.68%,attended by 56 cases(24.78%)of nephrotic syndrome,30 cases(13.27%)of solitary hematuria,and 26 cases(11.50%)of renal insufficiency.Among the primary nephropathy,IgA nephropathy is the most common,with 82 cases in total,accounting for 42.27%,followed by 52 cases(26.80%)of MsPGN,26 cases(13.40%)of MN,18 cases(9.28%)of MCD,16 cases(8.25%)of FSGS.Among nephrotic syndromes,MN is the most common,with 20 cases in total,accounting for 37.0%,followed by 16 cases(29.6%)of MCD,12 cases(22.2%)of MsPGN,2 cases(3.7%)of FSGS,2 cases(3.7%)of IgA nephropathy,2 cases(3.7%)of HSPN.Among secondary nephropathy,HSPN was the most common,with 8 cases,accounting for 40.0%,followed by 6 cases(30.0%)of DN,3 cases(15.0%)of hypertensive nephropathy,2 cases(10.0%)of gouty nephropathy,and 1 case(5.0%)of LN.Among hereditary nephropathy,thin basement membrane nephropathy is the most common,accounting for 83.3%.Conclusion Officers and soldiers who undergoing renal biopsy is mainly male soldiers in Gansu and Qinghai area,and which the soldiers are more active.The main cause is primary nephropathy,the incidence of secondary nephropathy is much lower than that in the general population,and hereditary nephropathy is not rare.The main pathological types of primary nephropathy are IgA nephropathy and MsPGN,secondary nephropathy is more common in HSPN and diabetic nephropathy,and most of hereditary nephropathy are thin basement membrane nephropathy.