中国单中心9310例肾活检病理诊断疾病谱

Disease spectrum of 9310 cases of renal biopsy pathological diagnosis from a single center in China

目的:肾脏疾病谱近10年来变化较大,但湖南地区缺乏较大数据的统计。本研究回顾性分析湖南地区近10年来肾脏疾病病理谱的构成特征,对比前后5年肾脏疾病病理类型的变化,旨在探讨肾脏疾病病理类型谱的变迁。方法:纳入中南大学湘雅二医院肾内科肾活检注册登记系统中2011年至2020年共计9310例肾活检病例。根据年龄将病例分为14~24岁、25~44岁、45~59岁及≥60岁4个年龄组,并将10年时间分为2011-2015年和2016-2020年2个时间段。根据肾小球疾病组织学分型,肾脏疾病病理类型分为原发性肾小球肾炎(primary glomerulonephritis,PGN)、继发性肾小球肾炎(secondary glomerulonephritis,SGN)、肾小管间质性肾炎(tubulo-interstitial nephritis,TIN)、遗传性肾脏病以及其他病理类型。结果:PGN病例占66.93%,其中IgA肾病(IgA nephropathy,IgAN)(42.83%)、膜性肾病(membranous nephropathy,MN)(19.16%)、微小病变性肾小球病(12.46%)及局灶节段性肾小球硬化症(focal segmental glomerulosclerosis,FSGS)(14.97%)是最常见的病理类型。与2011-2015年相比,2016-2020年IgAN(46.74%vs 37.33%)及MN(21.26%vs 16.18%)病例数明显增加,FSGS(12.81%vs 18.00%)呈下降趋势(均P<0.001);SGN病例占24.49%,其中狼疮性肾炎(lupus nephritis,LN)(26.91%)、高血压肾病(hypertensive renal disease,HT)(14.47%)、过敏性紫癜性肾炎(henoch-schonlein purpura nephritis,HSPN)(13.44%)及糖尿病肾病(diabetic nephrology,DN)(12.25%)是最常见的4种病理类型。在2011-2015年间,LN(32.53%)、HSPN(12.97%)、乙肝相关性肾炎(hepatitis B virus associated nephritis,HBVN)(10.98%)及HT(9.48%)是最常见的SGN病理类型;在2016-2020年间,HT(17.75%)比例增高,成为仅次LN(23.21%)的SGN病理类型,DN(15.84%)和HSPN(13.74%)分别位居第3和第4。在≤44岁的青壮年中,以LN常见,随着年龄的增长,HT、DN及单克隆免疫球蛋白相关肾损害(包括淀粉样变性肾病)构成比明显增高,成为SGN主要的病理类型。结论:IgAN仍然是近年中国肾脏疾病最主要的病理类型,IgAN在25~44岁这一年龄阶段比例最高,随着年龄的增长,构成比逐渐下降;MN病例在各个年龄阶段有不同程度的增长,HT、DN、单克隆免疫球蛋白相关肾损害病例均有增长趋势。该单中心肾脏病理疾病谱可为疾病的诊断、预防及流行病学研究提供参考依据。

Objective:The pathological types of renal diseases have changed in the past decade,but it lacks large sample analysis in Hunan Province.This study aims to retrospectively analyze the composition characteristics of pathological spectrum of kidney disease in Hunan Province in recent 10 years,compare the changes of pathological types of kidney disease.Methods:We collected a total of 9310 kidney biopsy cases from 2011 to 2020 registered in the kidney biopsy system of the Nephrology Institute of the Second Xiangya Hospital of Central South University.Patients were assigned into a 14−24 years old group,a 25−44 years old group,a 45−59 years old group,and a≥60 years old group,and divided into 2 time periods,namely 2011-2015 and 2016-2020.Pathological types of renal disease were divided into primary glomerulonephritis(PGN),secondary glomerulonephritis(SGN),tubulo-interstitial nephritis(TIN),hereditary kidney disease,and other pathological types.Results:PGN accounted for 66.93%cases.Among PGN,IgA nephropathy(IgAN)(42.83%),membranous nephropathy(MN)(19.16%),minimal change glomerulopathy(12.46%),and focal segmental glomerulosclerosis(FSGS)(14.97%)were the 4 most common pathological types.Compared with the group in the period of 2011-2015,IgAN(46.74%vs 37.33%)and MN(21.26%vs 16.18%)were increased significantly in years 2016-2020(both P<0.001).SGN accounted for 24.49%cases,of which lupus nephritis(LN)(26.91%),hypertensive nephropathy(HT)(14.47%),diabetic nephropathy(DN)(12.25%),and henoch-schonlein purpuric nephritis(HSPN)(13.44%)were the 4 most common pathological types.LN(32.53%),HSPN(12.97%),hepatitis B virus associated nephritis(HBVN)(10.98%),HT(9.48%)were the most common SGN in the period of 2011−2015.In the period of 2016−2020,the top 4 pathological types of SGN were LN(23.21%),HT(17.75%),DN(15.84%),and HSPN(13.74%).LN was the most common type in young adults≤44 years old.HT,DN,and monoclonal immunoglobulin associated renal disease(including amyloidosis nephropathy)became the main pathological types of SGN in middle-aged and elderly patients.Conclusion:IgAN remains the primary pathological type of kidney disease in China in the recent years.The patients with the age of 25−44 years old have the largest proportion of IgAN.With increases in age,the proportion of IgAN gradually decreases.MN increases to different degrees at various ages,while cases of HT,DN,and monoclonal immunoglobulin related renal damage have increased.This single-center renal pathology spectrum can provide clinical evidence for diagnosis,prevention and epidemiological study.