江西省单中心4314例肾活检临床病理与流行病学分析

Clinicopathological and Epidemiological Analysis of 4314 Cases of Renal Biopsy from A Single Center in Jiangxi Province

目的分析江西省部分地区近10年肾小球疾病谱构成及变化。方法回顾2009年1月至2018年12月南昌大学第一附属医院病理科经肾穿刺活检存档病例,重新评估其病理及临床诊治过程,对筛选出的肾小球疾病患者的临床流行病学特点、肾活检病理诊断类型及发病情况等进行分析。结果共筛选出符合条件的肾小球疾病患者4314例,男女比0.93:1。按年龄段分为青年组(14~35岁)1914例、中年组(36~55岁)1587例、老年组(56~70岁)813例。总发病率以青年组最高(44.37%)。青、中、老年组主要临床表现均以肾病综合征最高,分别为(41.80%、52.17%、61.25%)。青、中年组的IgA肾病(IgAN)比例最高,分别为43.86%、30.69%,且随年龄增大发病率逐渐下降(P<0.05);老年组膜性肾病(MN)发病率达46.39%,高于青、中年组的6.34%、29.39%(P<0.05)。与2009—2013年相比,2014—2018年青年组IgAN发病率下降(P<0.05);3组肾小球微小病变(MCD)发病率下降(P<0.05),而MN发病率上升(P<0.05)。结论江西省部分地区IgAN仍然是中青年患者中最常见肾小球疾病,随年龄增长,构成比下降。MN是老年人最常见肾病,在各年龄段呈逐年上升趋势,且继发因素复杂多样。正确进行病理组织学评估并明确病因,有利于临床诊疗。

Objective To analyze the composition and changes of glomerular disease spectrum in some areas of Jiangxi province in recent ten years.Methods The data of archived cases who underwent renal puncture biopsy in the department of pathology of the First Affiliated Hospital of Nanchang University from January 2009 to December 2018 were reviewed to reassess the pathology and clinical diagnosis and treatment process.The epidemiological characteristics,pathological types of renal biopsy and incidence of glomerular diseases were analyzed.Results A total of 4314 eligible patients with glomerular disease were screened with a male to female ratio of 0.93:1.These patients were divided into three age groups:young group(14-35 years old,1914 patients),middle-aged group(36-55 years old,1587 patients),and elderly group(56-70 years old,813 patients).The overall incidence was highest in young group(44.37%).Nephrotic syndrome was the most common clinical manifestation in all the three groups(41.80%,52.17%and 61.25%,respectively).The incidence of IgA nephropathy(IgAN)was highest in young group(43.86%)and middle-aged group(30.69%),and gradually decreased with age(P<0.05).The incidence of membranous nephropathy(MN)in elderly group(46.39%)was higher than that in young group(6.34%)and middle-aged group(29.39%)(P<0.05).Compared with 2009-2013,the incidence of IgAN in young group decreased in 2014-2018(P<0.05).The incidence of minimal glomerular disease decreased,but the incidence of MN increased in all the three groups(P<0.05).Conclusion IgAN is still the most common glomerular disease in young and middle-aged patients in some areas of Jiangxi province,and the composition ratio decreases with age.MN is the most common kidney disease in elderly patients,which shows an increasing trend in all age groups and has complex and diverse secondary factors.It is of great significance for clinical diagnosis and treatment to correctly evaluate the histopathology and clear the etiology.