本文選題：慢性腎臟病　切入點：原發(fā)性腎小球疾病　出處：《山東大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：慢性腎臟病(Chronic Kidney Disease,CKD)已經(jīng)成為一個全球關(guān)注的公共健康問題。綜合文獻(xiàn)報道慢性腎臟病的發(fā)病率高達(dá)每年每百萬人群中有200例-400例。大多數(shù)慢性腎臟病起病及進(jìn)展緩慢,癥狀隱匿,患者往往在“無癥狀”中,“突然”進(jìn)入終末期腎病(End Stage Renal Disease,ESRD)。慢性腎臟病被醫(yī)務(wù)人員稱為“沉默的殺手”�；颊咭坏┻M(jìn)入終末期腎病,就需要給予腎臟移植、血液透析或腹膜透析等花費高昂的腎臟替代治療,患者生命依賴醫(yī)院的程度明顯增加,給患者本人及家庭、社會造成巨大精神及經(jīng)濟壓力。北京大學(xué)第一醫(yī)院組織的多中心的全國性調(diào)查研究發(fā)現(xiàn),我國慢性腎臟病的發(fā)病率為10.8%一13%.其他發(fā)達(dá)國家慢性腎臟病的發(fā)病率與我國相近,比如,美國截止到2004年的數(shù)據(jù)顯示慢性腎臟病的發(fā)病率已逐年增加至13.1%。由于它的高發(fā)病率、低知曉率、預(yù)后差、花費巨大等特點,慢性腎臟病越來越引起人們的重視。最近一些研究表明在中國接受腎臟穿刺活檢病理檢查的患者中原發(fā)性腎小球疾病仍然是最為常見的腎臟疾病。原發(fā)性腎小球疾病在接受腎臟穿刺活檢的病理類型中占63.3%--71.1%。數(shù)量有限的單中心小規(guī)模研究表明近年來原發(fā)性腎小球疾病腎臟病理類型的比例不斷的發(fā)生著變化。變化之一是膜性腎病及IgA腎病的發(fā)病率顯著增加,但I(xiàn)gA腎病在中國及其他一些國家仍是最為常見的慢性腎小球疾病。研究發(fā)現(xiàn)IgA腎病在亞洲、歐洲、大洋洲中的發(fā)病率最高占原發(fā)性腎小球疾病的36.8-54.2%。但在同一時期,另有一些研究并未發(fā)現(xiàn)相同的趨勢。據(jù)我們所知,我國最近的腎臟疾病病理譜變化的統(tǒng)計分析要追溯至2012,至今3年過去了,是否有新的變化呢?另外,目前的研究都是小規(guī)模的單中心研究,為了能夠更加深入的分析最新的原發(fā)性腎小球疾病病理類型的變化,我們收集了來自山東省2家大型腎臟病理檢查中心共37家醫(yī)院最近5年的腎臟穿刺病理結(jié)果進(jìn)行統(tǒng)計分析。研究目的：在中國,原發(fā)性腎小球疾病仍是最為常見的腎臟疾病類型。數(shù)量有限的單中心小規(guī)模分析研究表明膜性腎病發(fā)病率逐年升高。然而,IgA腎病仍是最為常見的原發(fā)性腎小球疾病。劇我們所知,目前在中國還沒有關(guān)于原發(fā)性腎小球疾病譜變化的多中心研究。為更加深入的研究腎臟組織病理類型變化,收集了來自山東省2家大型腎臟病理檢查中心37家醫(yī)院近5年的腎臟穿刺病理結(jié)果進(jìn)行統(tǒng)計分析。以期發(fā)現(xiàn)腎臟病理疾病譜的最新變化趨勢。研究方法：在這個橫斷面回顧性研究中,我們選取2010年6月到2015年5月來自山東省兩家大型腎臟病理中心(山東省千佛山醫(yī)院病理科及濟南銀豐醫(yī)學(xué)研究中心)共37家醫(yī)院6017名接收腎穿刺的患者作為研究對象進(jìn)行統(tǒng)計分析。剔除一般資料記錄不完整的21人,剔除腎組織標(biāo)本不充分的44人(即光鏡下腎小球小于10個,并且免疫熒光或電鏡下沒有典型發(fā)現(xiàn)者),剔除重復(fù)腎活檢標(biāo)本17人。因此,在此回顧性研究中納入5935個合格的樣本。其中,4855(81.8%)病人診斷為原發(fā)性腎小球疾病。根據(jù)患者年齡分為4個組別(兒童患者組≤18歲,青年患者組19-44歲,中年患者組45-59歲,老年患者組≥60歲)。以1年為一個時間間隔共分為5個階段進(jìn)行統(tǒng)計分析。研究結(jié)果：在4855例原發(fā)性腎小球疾病患者中,2610(53.8%)為男性,2245(46.2%)為女性。腎組織樣本患者的平均年齡為39.78±15.43歲(從1歲到88歲)。5個時期中平均年齡分別為39.3±14.4歲,38.1±13.9歲,39±15.8歲,40.2±16.1歲,41.6±15.9歲。根據(jù)年齡分層分析提示原發(fā)性腎小球腎炎在青年患者(19-44歲)中發(fā)病率最高,2623例(54.0%),其他依次是中年患者(45-59歲)1317例(27.1%),老年患者(≥60歲)555例(11.4%),兒童患者(≤18歲)349例(7.2%)。在整個研究時期和不同階段原發(fā)性腎小球疾病的病理類型變化：在4855個原發(fā)性腎小球疾病患者中,占首位的病理類型是膜性腎病(2103,43.3%),其他依次是IgA腎病(1655,34.1%),微小病變(488,10.3%),局灶節(jié)段性腎小球硬化(332,6.8%),膜增生性腎小球腎炎(64,1.3%),硬化性腎小球腎炎(49,1.0%),新月體性腎小球腎炎(45,0.9%),毛細(xì)血管內(nèi)增生腎小球腎炎(37,0.8%)和系膜增生性腎小球腎炎(27,0.6%)。根據(jù)年度分段后發(fā)現(xiàn)膜性腎病的的比例逐年明顯增加,依次為30.7%,34.5%,39.4%,50.7%,53.5%。另外,從第3年度開始膜性腎病取代IgA腎病成為原發(fā)性腎小球疾病的最主要病理類型。IgA腎病在第1、2年是原發(fā)性腎小球疾病的最主要病理類型。然而,其比例從第2年的41.8%逐年下降至第5年的25.2%(p0.001)。局灶節(jié)段性腎小球硬化性腎小球疾病的比例從第2年的11.1%下降至第5年的4.1%。微小病變的比例在第1年最高為17.8%,但第5年下降至9.6%。根據(jù)年齡分層后原發(fā)性腎小球疾病的病理類型變化：根據(jù)年齡分層后分析發(fā)現(xiàn),隨著年齡的增加,膜性腎病的比例顯著增加,依次為兒童患者29.8%,青年患者38.3%,中年患者48.6%,老年患者63.2%。與之相反,微小病變呈現(xiàn)相反的走勢。IgA腎病于青年患者中發(fā)病率最高(38.5%),隨著年齡增加其比例不斷下降,至老年的(18.9%)。根據(jù)年齡分層后分析發(fā)現(xiàn),在每個年齡層面膜性腎病的比例均呈現(xiàn)逐年增加的趨勢。然而,IgA腎病所占的比例幾乎在每個年齡層面呈現(xiàn)相反的逐年下降趨勢。此外,IgA腎病在青年人中發(fā)病率最高。在349位兒童患者(≤18歲)原發(fā)性腎小球疾病中,排在首位的病理類型為IgA腎病(121,34.7%),其他依次為膜性腎病(104,29.8%),微小病變(71,20.3%),毛細(xì)血管內(nèi)增生腎小球腎炎(16,4.6%),局灶節(jié)段硬化性腎小球疾病(15,4.3%),膜增生性腎小球腎炎(6,1.7%),硬化性腎小球疾病(5,1.4%),新月體性腎小球腎炎(2,0.6%),系膜增生性腎小球腎炎(1,0.3%)。在青年患者中,IgA腎病是最常見的原發(fā)性腎小球疾病(38.5%),其他依次為膜性腎病(38.3%),微小病變(10.6%),局灶節(jié)段硬化性腎小球疾病(8%),硬化性腎小球疾病(1.1%),膜增生性腎小球腎炎(0.9%),新月體性腎炎(0.7%),系膜增生性腎小球腎炎(0.6%),毛細(xì)血管內(nèi)增生性腎小球腎炎(0.5%)。在中年患者中,膜性腎病均成為最主要的病理類型(48.6%),其他依次為IgA腎病(31.5%),微小病變(8.0%),局灶節(jié)段硬化性腎小球疾病(6.4%),膜增生性腎小球腎炎(1.6%),新月體性腎小球腎炎(1.0%),硬化性腎小球疾病(0.8%),毛細(xì)血管內(nèi)增生腎小球腎炎(0.5),系膜增生性腎小球腎炎(0.5%)。在老年患者中,膜性腎病均成為最主要的病理類型(63.2%),其他依次為IgA腎病(18.9%),微小病變(5.8%),局灶節(jié)段硬化性腎小球疾病(4.0%),膜增生性腎小球腎炎(2.5%),新月體性腎小球腎炎(2.0%),硬化性腎小球疾病(0.9%),毛細(xì)血管內(nèi)增生腎小球腎炎(0.5%),系膜增生性腎小球腎炎(0.4%)�？傊�,在5935例合格的腎穿刺患者中,原發(fā)性腎小球疾病有4855例,占81.8%。其中膜性腎病(43.3%)成為最為常見的原發(fā)性腎小球疾病,而IgA腎病退至第二位(34.1%)(P0.001)。膜性腎病的發(fā)病率從第1年的30.7%增加到第5年的53.5%(P0.001)。膜性腎病的發(fā)病率在每個年齡階段都呈現(xiàn)增加趨勢。在第1、2年期間IgA仍然是原發(fā)性腎小球疾病的主要原因。然而,IgA所占比例明顯下降,從第2年的41.8%下降至第5年的25.2%(p0.001)。研究結(jié)論：我們的分析研究表明,原發(fā)性腎小球疾病仍然是目前最為常見的腎臟疾病。在各個年齡層面,膜性腎病的發(fā)病率逐年增加,IgA的發(fā)病率逐年下降成為近5年原發(fā)性腎小球疾病病理類型比例變化的主旋律。我們目前的橫斷面研究首次表明膜性腎病取代IgA腎病成為原發(fā)性腎小球疾病的最主要的病理類型
[Abstract]:Chronic kidney disease (Chronic Kidney, Disease, CKD) has become a global public health concern. According to literature reported incidence of chronic kidney disease rate per million people in 200 cases of -400 patients. The majority of chronic kidney disease onset and slow progress, symptoms hidden, patients are often asymptomatic. "Suddenly" end-stage renal disease (End Stage Renal Disease, ESRD). Chronic kidney disease by the medical staff called the "silent killer". Once in the patients with end-stage renal disease, we need a kidney transplant, hemodialysis or peritoneal dialysis and costly renal replacement therapy, patients with life on hospital increased significantly, to patients and their families, society caused great spiritual and economic pressure. The study of national survey center of No.1 Hospital of Peking University of the organization found that China's incidence of chronic kidney disease rate was 1 0.8% other developed countries 13%. incidence of chronic kidney disease was similar, and in China for example, the United States by the end of 2004 data show that the incidence of chronic renal diseases has increased to 13.1%. because of its high incidence, low awareness rate, poor prognosis, costly features, more and more people with chronic kidney disease attention. Recently some studies show that received renal biopsy in patients with primary glomerular disease in China is still the most common kidney disease. Primary glomerular diseases accounted for the single center study of small scale 63.3%--71.1%. in a limited number of pathological types of renal biopsy in accepting that in recent years the primary renal glomerular diseases the proportion of type changing. One of the changes is a significant increase in the incidence of membranous nephropathy and IgA nephropathy, IgA nephropathy and other Chinese but in some countries still Is the most common chronic glomerular disease. The study found that IgA nephropathy in Asia, Europe, the incidence in Oceania accounted for the highest rate of primary glomerular disease 36.8-54.2%. but at the same time, some studies have not found the same trend. As far as we know, the statistical changes in China's recent kidney pathological spectrum analysis going back to 2012, since the past 3 years, whether there are new changes? In addition, the present study is a single center study of small scale, in order to more in-depth analysis of the new type of primary glomerular disease pathological changes, we collected from Shandong Province, 2 large renal pathology center with a total of 37 hospitals in the recent 5 years renal biopsy pathological results were statistical analysis. The purpose of this study is to Chinese, primary glomerular diseases are the most common type of kidney disease. A limited number of small single center Analysis shows that membranous nephropathy incidence increased year by year. However, the most common primary glomerular disease, IgA nephropathy is still play. We know, at present in China no multicenter study on primary glomerular disease spectrum changes. The type of kidney disease changes as the research more in-depth, collected from Shandong Province, 2 large renal pathological examination center of 37 hospitals in nearly 5 years of renal biopsy pathological results were analyzed. In order to find out the latest trends of renal pathological disease. Methods: in this cross-sectional retrospective study, we selected from June 2010 to May 2015 from Shandong Province, two large renal pathological Center (Department of pathology Shandong Province, Qianfo Hill hospital and Ji'nan Yinfeng medical research center, a total of 37 hospitals) 6017 received renal biopsy patients as the research object were analyzed. The general information can eliminate 褰曚笉瀹屾暣鐨，

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