本文選題：兒童 + 腎穿刺活檢��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究目的將我院近20年期間保存完整的經(jīng)皮腎活檢兒童的臨床資料及病理資料加以整理分析,對(duì)病理類型的分布、臨床癥狀與病理類型的關(guān)系以及部分重復(fù)腎活檢穿刺患兒病理的動(dòng)態(tài)變化進(jìn)行探討和總結(jié),充分認(rèn)識(shí)經(jīng)皮腎穿刺活檢術(shù)在兒童腎臟疾病中的重要性,為臨床工作中兒童腎臟疾病的正確診斷和規(guī)范治療提供有參考價(jià)值的指導(dǎo)資料。研究方法回顧性分析1995～2015年山東省立醫(yī)院兒科的753例腎臟疾病患兒病例。在超聲的引導(dǎo)下,所有入選病例均進(jìn)行經(jīng)皮腎穿刺活檢術(shù),并對(duì)活檢標(biāo)本進(jìn)行光鏡染色(HE染色、PAS染色、PASM染色、Masson染色)、直接免疫熒光染色(IgA、IgG、IgM、Fibrin、Clq、C3),部分行乙型肝炎病毒抗原免疫組化染色及電鏡檢查。參考WHO在1982年制定的腎小球疾病組織學(xué)分型方案及后來(lái)改良的1995年版、中華醫(yī)學(xué)會(huì)腎臟病分會(huì)在2001年制定的腎活檢病理診斷標(biāo)準(zhǔn)對(duì)患兒做出病理診斷,參考2000年11月中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)腎臟病學(xué)組在珠海研討會(huì)上制定的兒童腎臟疾病臨床診斷標(biāo)準(zhǔn)對(duì)患兒做出臨床診斷。并收集其主要的臨床資料、病理資料及相關(guān)實(shí)驗(yàn)室檢查結(jié)果等指標(biāo),對(duì)收集的相關(guān)資料進(jìn)行仔細(xì)核實(shí)后,再有條理的依次錄入計(jì)算機(jī)中。在EXCEL軟件中建立整體的數(shù)據(jù)庫(kù),然后使用SPSS 22.0軟件加以統(tǒng)計(jì)分析。結(jié)果1.在753例行經(jīng)皮腎穿刺活檢的患兒中,男性442例,女性311例,其中男:女比例為1.42:1,入選病例年齡在1.3-15歲之間,平均(8.72±2.47)歲�？煞譃�4大類,包括原發(fā)性腎小球疾病(428例,占56.84%)、繼發(fā)性腎小球疾病(306例,占40.63%)、遺傳性腎臟疾病(17例,占2.26%)、腎小管間質(zhì)性疾病(2例,占 0.27%)。2.在臨床診斷中原發(fā)性腎病綜合征的患兒最為常見,共219例,占29.08%,其他依次為紫癜性腎炎(193例,占25.63%)、急性腎炎綜合征(134例,占17.79%)、狼瘡性腎炎(84例,占11.16%)、孤立性血尿(34例,占4.52%)等。3.在病理類型中系膜增生性腎小球腎炎的患兒最為常見,共367例,占48.74%,其他依次為IgA腎病(154例,占20.45%)、微小病變(79例,占10.49%)、膜性腎病(40例,占5.32%)、局灶節(jié)段性腎小球硬化(24例,占3.19%)等。4.腎活檢腎臟疾病的變化趨勢(shì):近20年間腎活檢腎臟疾病構(gòu)成比出現(xiàn)了一定變化,原發(fā)性腎小球疾病中局灶節(jié)段性腎小球硬化、IgA腎病、膜性腎病及微小病變?cè)诟麟A段所占比例逐漸增加,系膜增生性腎小球腎炎所占比例逐漸減少;繼發(fā)性腎小球疾病中乙型肝炎病毒相關(guān)性腎炎在各階段所占比例顯著減少。5.臨床診斷與病理類型的關(guān)系:原發(fā)性腎小球疾病中最常見的臨床診斷和病理類型分別為原發(fā)性腎病綜合征和IgA腎病,繼發(fā)性腎小球疾病中最常見的臨床診斷和病理類型分別為紫癜性腎炎和系膜增生性腎小球腎炎,薄基底膜腎病和Alport綜合征是最常見的兩種遺傳性腎臟疾病。6.重復(fù)腎活檢:8例重復(fù)腎活檢患兒的病理類型及臨床癥狀均出現(xiàn)了一定的變化。7.提高臨床診斷水平:腎穿刺活檢術(shù)后根據(jù)腎臟組織病理結(jié)果糾正臨床診斷287例,對(duì)于臨床疾病初步診斷的修正率為38.1%。結(jié)論1.兒童腎臟疾病中是以原發(fā)性腎小球疾病為主,最常見的臨床診斷和病理類型分別為原發(fā)性腎病綜合征和系膜增生性腎小球腎炎。2.近20年間,原發(fā)性腎小球疾病中IgA腎病、局灶節(jié)段性腎小球硬化、微小病變及膜性腎病患兒的發(fā)病率呈現(xiàn)上升趨勢(shì),系膜增生性腎小球腎炎則較前下降;同時(shí),繼發(fā)性腎小球疾病中乙型肝炎病毒相關(guān)性腎炎的發(fā)病率呈顯著下降趨勢(shì)。3.兒童腎臟疾病的臨床表現(xiàn)和病理類型并不完全一致,因此需綜合考慮患兒的病理及臨床資料,必要時(shí)行進(jìn)一步的基因檢測(cè),才能做出正確的診斷,進(jìn)而選擇合適的治療方案。4.重復(fù)腎穿刺活檢有助于及時(shí)掌握患者病理類型的轉(zhuǎn)化,從而相應(yīng)的調(diào)整治療方案。
[Abstract]:The purpose of this study was to analyze the clinical data and pathological data of the complete percutaneous renal biopsy in our hospital during the last 20 years. The distribution of pathological types, the relationship between the clinical symptoms and pathological types, and the pathological changes of the children with partial renal biopsy were discussed and summarized, and the percutaneous renal biopsy was fully recognized. The importance of the renal disease in children provides valuable guidance for the correct diagnosis and standardized treatment of children's renal diseases in clinical work. A retrospective analysis of 753 cases of children with renal diseases in the pediatric department of Shangdong Province-owned Hospital in 1995~2015 years. Under the guidance of ultrasound, all the selected cases were performed percutaneous Nephrology. Biopsy specimens were performed with light microscopy (HE, PAS, PASM, Masson), direct immunofluorescence staining (IgA, IgG, IgM, Fibrin, Clq, C3), some of the hepatitis B virus antigen immunohistochemical staining and electron microscopy. Reference WHO in 1982, the histological classification scheme of glomerular diseases and the later improvement of 1 The 995 Year Edition, the kidney disease branch of the Chinese Medical Association, made a pathological diagnosis of renal biopsy in 2001, and made a clinical diagnosis of children's kidney disease clinical diagnostic criteria established by the kidney disease group of the Chinese Medical Association in November 2000 at the Zhuhai Symposium and collected its main clinical diagnosis. Data, pathological data and the results of the related laboratory examination were carefully checked into the computer. The whole database was established in the EXCEL software, and then the SPSS 22 software was used for statistical analysis. Results 1. of the 753 cases of children with percutaneous renal biopsy, 442 cases were male. There were 311 female cases, of which male: female ratio was 1.42:1, the age of the selected cases was between 1.3-15 years, average (8.72 + 2.47) years old. It could be divided into 4 categories, including primary glomerular disease (428 cases, 56.84%), secondary glomerular disease (306 cases, 40.63%), hereditary renal disease (17 cases, 2.26%), and renal tubulointerstitial disease (2, 0.27%).2. in clinical Children were most common in the diagnosis of idiopathic nephrotic syndrome in 219 cases, accounting for 29.08%. The others were purpuric nephritis (193 cases, 25.63%), acute nephritis syndrome (134 cases, 17.79%), lupus nephritis (84 cases, 11.16%), isolated hematuria (34 cases, 4.52%) and other.3. in the pathological type of mesangial proliferative glomerulonephritis in children A total of 367 cases, a total of 48.74%, and the others were IgA nephropathy (154 cases, 20.45%), small lesions (79 cases, 10.49%), membranous nephropathy (40, 5.32%), focal segmental glomerulosclerosis (24, 3.19%) and other.4. renal biopsy changes: renal biopsy in the last 20 years had a certain change in renal biopsy, primary renal minor The proportion of focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy and minor lesions in all stages of the disease gradually increased, and the proportion of mesangial proliferative glomerulonephritis gradually decreased, and the proportion of hepatitis B Virus Related Nephritis in secondary glomerulonephritis significantly reduced the clinical diagnosis and pathological types of.5.. The most common clinical diagnosis and pathological types of primary glomerular diseases are primary nephrotic syndrome and IgA nephropathy. The most common clinical diagnosis and pathological types of secondary glomerular diseases are purpuric nephritis and mesangial proliferative glomerulonephritis respectively, and thin basement membrane nephropathy and Alport syndrome are the most common types of secondary glomerular disease. Two kinds of hereditary renal diseases.6. repeat renal biopsy: 8 cases of repeated renal biopsy of the pathological type and clinical symptoms have changed a certain amount of.7. to improve the clinical diagnosis: renal biopsy after renal biopsy correction of 287 cases of clinical diagnosis, the correction rate of primary diagnosis of clinical disease is 38.1%. conclusion 1. children The most common clinical diagnosis and pathological types are primary nephrotic syndrome and mesangial proliferative glomerulonephritis.2., the most common clinical diagnosis and pathological types are primary glomerulonephritis and mesangial glomerulonephritis. The incidence of IgA nephropathy, focal segmental glomerulosclerosis, small lesions, and membranous nephropathy in children with primary glomerular disease is increasing in 20 years. Trend, mesangial proliferative glomerulonephritis is lower than before, and the incidence of hepatitis B virus associated glomerulonephritis in secondary glomerulopathy is significantly decreased. The clinical and pathological types of renal diseases in.3. children are not completely consistent. Therefore, the pathological and clinical data of the patients need to be taken into consideration. Gene detection can make the correct diagnosis, and then select the appropriate treatment program.4. repeat renal biopsy can help to timely master the transformation of the patient's pathological type, and accordingly adjust the treatment plan.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王艷秋;秦麗麗;孫廣萍;李德天;;1562例經(jīng)皮腎穿刺活檢患者的臨床及病理分析[J];中國(guó)全科醫(yī)學(xué);2015年15期

2 李玉峰;衛(wèi)敏江;吳偉嵐;陳慧敏;沈加;董瑜;金晶;;兒童腎活檢977例病理及臨床分析[J];上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年03期

3 成學(xué)琴;鮑華英;張愛華;丁桂霞;趙非;;兒童狼瘡性腎炎45例臨床、病理及免疫學(xué)分析[J];臨床兒科雜志;2014年03期

4 周曉萍;羅惠民;袁紅伶;;薄基底膜腎病臨床和病理的相關(guān)性研究[J];昆明醫(yī)科大學(xué)學(xué)報(bào);2013年01期

5 尹曉玲;鄒敏書;王嘉;劉銅林;唐錦輝;仇麗茹;陳瑜;袁惠卿;周建華;;單中心兒童腎活檢1579例臨床和病理類型分析[J];中國(guó)循證兒科雜志;2012年06期

6 王明軍;莫曉露;;1616例腎臟疾病的臨床病理類型探討[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2012年05期

7 馮立英;王志東;;腎活檢239例病理資料分析[J];中國(guó)藥物與臨床;2012年04期

8 鄭瀊冰;徐虹;周利軍;曹琦;孫利;沈茜;郭維;方曉燕;張俊;劉海梅;陳徑;;從復(fù)旦大學(xué)附屬兒科醫(yī)院31年腎臟病理及臨床資料反思腎活檢指征[J];中國(guó)循證兒科雜志;2011年03期

9 李克莉;劉大衛(wèi);武文娣;許滌沙;涂秋鳳;鄭敏;丁崢嶸;唐婷婷;韓悅;方興;王華慶;羅會(huì)明;梁曉峰;;中國(guó)六個(gè)市2007～2009年過(guò)敏性紫癜住院病例發(fā)病情況分析[J];中國(guó)疫苗和免疫;2011年02期

10 邱霞;環(huán)文英;;104例腎臟穿刺活檢臨床與病理分析[J];中國(guó)實(shí)用醫(yī)藥;2010年30期

，

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