2012—2021年单中心2087例经皮肾穿刺活检患者病理类型分布特点

Distribution characteristics of pathological types of 2087 patients undergoing renal biopsies at a single center from 2012 to 2021

目的分析2012—2021年某三甲医院收治的2087例经皮肾穿刺活检患者病理类型的分布特点。方法收集2012—2021年在某三甲医院接受肾穿刺活检的2087例患者临床病理资料,依据年龄分为18~39岁818例、40~59岁858例、60岁及以上411例,依据时间分为第一阶段(2012—2016年)、第二阶段(2017—2021年),对采集的数据进行分析。结果2087例患者中,原发性肾小球疾病1674例(80.2%),继发性肾脏病293例(14.0%),肾血管疾病37例(1.8%),肾小管间质疾病39例(1.9%),复合型肾病30例(1.4%),遗传性肾病14例(0.7%)。原发性肾小球疾病中常见的病理类型依次为IgA肾病、膜性肾病、肾小球微小病变;继发性肾脏病中常见的病理类型依次为糖尿病肾病、狼疮肾炎、有肾脏意义的单克隆免疫球蛋白病。原发性肾小球疾病:18~39岁病理类型以IgA肾病(50.5%)、膜性肾病(17.1%)、肾小球微小病变(14.8%)最为常见,40~59岁常见的病理类型是IgA肾病(38.9%)、膜性肾病(28.8%)、局灶节段性肾小球硬化症(13.5%),60岁及以上常见的病理类型是膜性肾病(51.4%)、IgA肾病(15.6%)、肾小球微小病变(12.9%)。继发性肾脏病:18~39岁常见的病理类型为狼疮肾炎(45.2%)、糖尿病肾病(16.7%)、过敏性紫癜性肾炎(15.5%),40~59岁常见的病理类型是糖尿病肾病(49.2%)、狼疮肾炎(13.9%)、有肾脏意义的单克隆免疫球蛋白病(12.3%),60岁及以上常见的病理类型是糖尿病肾病(43.7%)、有肾脏意义的单克隆免疫球蛋白病(20.7%)、过敏性紫癜性肾炎(11.5%)。2017—2021年原发性肾小球疾病占比低于2012—2016年,继发性肾脏病、复合型肾病占比高于2012—2016年(P均<0.05)。原发性肾小球疾病中,2017—2021年肾小球微小病变、系膜增生性肾小球肾炎占比低于2012—2016年(P均<0.05);在继发性肾脏病中,2017—2021年糖尿病肾病占比高于2012—2016年,狼疮肾炎、过敏性紫癜性肾炎占比低于2012—2016年(P均<0.05)。结论2012—2021年该三甲医院原发性肾小球疾病是成人肾活检最常见的病理类型,其中IgA肾病、膜性肾病最为常见;继发性肾脏病的发病率呈增长趋势,糖尿病肾病增长明显,成为最常见的继发性肾脏病理类型。随着年龄增长,膜性肾病、糖尿病肾病、有肾脏意义的单克隆免疫球蛋白病检出率升高,而IgA肾病、狼疮肾炎检出率下降。此外,IgA肾病合并膜性肾病、糖尿病肾病合并IgA肾病、糖尿病肾病合并膜性肾病等复合型肾病的检出率增高。

Objective To evaluate the distribution characteristics of pathological types of 2087 patients who received renal biopsies in one three-A hospital from 2012 to 2021.Methods The clinical and pathological data of 2087 cases of patients from 2012 to 2021 were collected.The patients were then divided into three age groups(818 cases of 18-39 years,858 cases of 40-59 years,and 411 cases of≥60 years)and 2 subperiods(2012-2016 and 2017-2021).The statistical analysis of all data was performed by SPSS 22.0 software.Results Among the 2087 enrolled cases,primary glomerulonephritis(PGN,80.2%)was found in 1674 cases,secondary renal disease(SRD,14.0%)in 293,renal vascular disease(RVD,1.8%)in 37,tubulointerstitial disease(TID,1.9%)in 39,compound glomerular disease(CGD,1.4%)in 30,and hereditary and congenital renal disease(HCRD,0.7%)in 14.The most frequent pathological types of PGN were IgA nephropathy(IgAN),membranous nephropathy(MN)and glomerular minimal change disease(MCD).And diabetic nephropathy(DN),lupus nephritis(LN),monoclonal gammopathy of renal significance(MGRS)were the most common pathological types of SRD.The most pathological types of PGN were IgAN(50.5%),MN(17.1%),MCD(14.8%)in 18-39 years group,and IgAN(38.9%),MN(28.8%),focal segmental glomerulosclerosis(FSGS,13.5%)in 40-59 years group,and MN(51.4%),IgAN(15.6%),MCD(12.9%)in≥60 years group.The most pathological types of SRD were LN(45.2%),DN(16.7%),and Henoch-Schönlein purpura nephritis(HSPN,15.5%)in 18-39 years group,and DN(49.2%),LN(13.9%),MGRS(12.3%)in 40-59 years group,and DN(43.7%),MGRS(20.7%),HSPN(11.5%)in≥60 years group.Compared to the 2012-2016 period,PGN decreased,while SRD and CGD increased during the 2017-2021 period(all P<0.05),the prevalence of DN significantly increased(P<0.05),and MCD,mesangial proliferative glomerulonephritis(MsPGN),LN,HSPN significantly decreased over time(all P<0.05).Conclusions PGN remained the most prevalent pathological type from 2012 to 2021 in this three-A hospital,and IgAN,MN were the most common pathological types of PGN.The SRD grew rapidly in the past decade,notably,DN became the most common type of SRD at our center.With advancing age,the detection rates of MN,DN,and MGRS increased,while those of IgAN and LN showed a falling trend.Additionally,the detection rate of CGD increased.