【摘要】：目的回顧性分析單中心10年間成人腎活檢資料的流行病學(xué)、臨床特征和病理類型的分布特點(diǎn),比較分析不同時(shí)期腎活檢病理診斷譜的變化情況,初步探討10年間腎活檢流行病學(xué)特點(diǎn)的變化。方法選擇2007年1月至2016年12月在我科行腎穿刺活檢的15歲及以上的病例,根據(jù)時(shí)間分為2007—2010年(前期組)、2011—2013年(中期組)和2014—2016年(近期組)3個(gè)時(shí)間組,根據(jù)年齡分為15~39歲組、40~64歲組和65歲及以上組。收集并采用SPSS 18.0軟件分析所有患者的臨床病理資料。結(jié)果共入選1 786例臨床病理資料完整的腎活檢病例。男性973例,女性813例,中位年齡42(15~88)歲。原發(fā)性腎小球疾病1 548例,其中IgA腎病最常見(jiàn),占所有病例的29.1%(520/1 786),微小病變腎病占17.3%(309/1 786),膜性腎病占17.0%(304/1 786)。繼發(fā)性腎臟疾病238例,其中最常見(jiàn)的為狼瘡性腎炎,占所有腎活檢病例的3.4%(61/1 786),其次為糖尿病腎病(2.9%,51/1 786)和紫癜性腎炎(2.2%,39/1 786)。3個(gè)時(shí)期組患者性別、年齡差異無(wú)統(tǒng)計(jì)學(xué)意義;中期組(90/547,16.5%)和近期組(148/555,26.7%)膜性腎病比例高于前期組(66/684,9.6%;P0.01)。所有病例的臨床表現(xiàn)以腎炎綜合征最常見(jiàn)(812/1 786,45.5%),腎病綜合征次之(688/1 786,38.5%)。15~39歲組以腎病綜合征為臨床表現(xiàn)的病例中最常見(jiàn)的為微小病變腎病(122/295,41.4%),40~64歲組和65歲及以上組最常見(jiàn)的為膜性腎病(122/312,39.1%;36/81,44.4%)。15~39歲組和40~64歲組腎炎綜合征最常見(jiàn)的病理診斷均為IgA腎病(227/403,56.3%;144/381,37.8%),65歲及以上組為膜性腎病(9/28,32.1%)。結(jié)論 IgA腎病是最常見(jiàn)的腎小球疾病,近年來(lái)膜性腎病的發(fā)病率有顯著升高的趨勢(shì),值得關(guān)注。IgA腎病是中青年腎炎綜合征病例最常見(jiàn)的病理診斷,膜性腎病是中老年腎病綜合征病例最常見(jiàn)的病理診斷。
[Abstract]:Objective to retrospectively analyze the epidemiology, clinical features and pathological types of renal biopsy data in adults during the past 10 years, and to compare and analyze the changes of pathological diagnosis spectrum of renal biopsy in different periods. Objective: to investigate the epidemiological characteristics of renal biopsy in 10 years. Methods from January 2007 to December 2016, the patients aged 15 and above who underwent renal biopsy in our department were divided into three groups according to the time: 2007-2010 (Prophase group), 2011-2013 (interim group) and 2014-2016 (recent group). According to the age, they were divided into 1539 years old group, 4064 years old group and 65 years old and above group. The clinicopathological data of all patients were collected and analyzed by SPSS 18.0 software. Results A total of 1,786 renal biopsy cases with complete clinicopathologic data were selected. There were 973 males and 813 females with a median age of 42 (1588) years. Of the 1 548 cases of primary glomerular disease, IgA nephropathy was the most common, accounting for 29.1% (520 / 1,786) of all cases, minimal lesion nephropathy 17.3% (309 / 1,786), membranous nephropathy 17.0% (304 / 1,786). Among 238 cases of secondary renal diseases, lupus nephritis was the most common one, accounting for 3.4% (61 / 1,786) of all renal biopsy cases, followed by diabetic nephropathy (2.9%) and Henoch-Schonlein purpura nephritis (2.2% / 391,786). The percentage of membranous nephropathy in the metaphase group (90 / 547 / 16.5%) and the recent group (148 / 555 ~ 26.7%) was higher than that in the pre-stage group (66 / 684 / 9.6 / P0.01). The most common clinical manifestations of all cases were nephritis syndrome (812 / 1786 / 45.5%), nephrotic syndrome (688 / 1786 / 38.5%) .1539 years old group with nephrotic syndrome as the most common clinical manifestations of minimal change nephropathy (122 / 2951.4%) 4064 years old group and 65 years old and over group the most common. The most common pathological diagnosis of glomerulonephritis syndrome in 1539 years old group and 4064 years old group was IgA nephropathy (227 / 403 / 56.43 / 37.8%) and membranous nephropathy (92832.21%) in 65 years old and over. Conclusion IgA nephropathy is the most common glomerular disease. In recent years, the incidence of membranous nephropathy has a significant increasing trend, and it is worthy of attention that .IgA nephropathy is the most common pathological diagnosis in young and middle-aged patients with glomerulonephritis syndrome. Membranous nephropathy (MNS) is the most common pathological diagnosis in middle-aged patients with nephrotic syndrome.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院腎內(nèi)科;
【基金】：國(guó)家自然科學(xué)基金(81600550) 上海市衛(wèi)生與計(jì)劃生育委員會(huì)青年科研項(xiàng)目(2012Y104)~~
【分類號(hào)】：R692

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