1 773例肾活检临床病理分析

A clinico-pathological analysis of renal biopsies of 1 773 patients

摘要:

目的：了解重庆地区肾活检患者临床与病理类型特点并分析其相互关系。方法：收集2008年1月至2016年12月在重庆医科大学附属第一医院年龄≥14岁的肾活检患者的临床和病理资料，依据性别、年龄和临床表现分组，对其病理类型进行比较和分析。结果：1 773例肾活检患者纳入分析，男女比例1∶1.13，平均年龄（43.24±13.78）岁。①原发性肾小球疾病（primary glomerulonephritis，PGN）1 380例（77.8%），继发性肾小球疾病（secondary glomerulonephritis，SGN）368例（20.8%），肾小管间质疾病（tubulo-interstitial nephropathy，TIN）24例（1.3%），遗传性肾病（hereditary glomeruler diseases，HGD）1例（0.1%）。青年组、中年组和老年组都以PGN多见，但PGN和SGN在３个年龄组中的构成比差异无统计学意义（P=0.069）。②PGN病理类型以IgA肾病（IgA nephropathy, IgAN; 567例, 41.1%）、系膜增生性肾小球肾炎（mesangial proliferative glomerulonephritis, MsPGN；311例, 22.5%）、膜性肾病（membranous nephropathy，MN；202例，14.6%）为主；SGN病理类型以狼疮性肾炎（1upus nephritis，LN；134例, 36.4%）、紫癜性肾炎（Henoch-schonlein purpura nephritis，HSPN；74例，20.1%）、乙肝病毒相关性肾炎（HBV-associated glomeru－lonephritis，HBV-GN；68例，18.5%）为主；PGN各病理类型在3个年龄组中的构成比差异有统计学意义（P=0.000），其中IgAN是青年组、中年组最常见的病理类型，老年组则以MN最常见。③PGN的临床表现以肾病综合征（557例，40.3%）和慢性肾小球肾炎（471例，34.2%）为主；肾病综合征最常见的病理类型是MN，慢性肾小球肾炎则以IgAN最常见。④SGN各病理类型的男女性别构成比差异有统计学意义（P=0.000），具体表现在LN以女性多见，HSPN、HBV-GN、糖尿病肾病（diabetic nephropathy，DN）以男性多见。⑤LN和HSPN病理分级分别以Ⅳ型（68例，50.7%）和ⅢB型（41例，55.4%）最常见；HBV-GN最常见的病理类型是MsPGN （24例，35.3%）。结论：肾脏疾病病理类型与性别、年龄、临床表现之间有一定联系，但并未构成规律的对应关系，故对于肾脏疾病患者，不单限于临床诊断，亦应行肾活检明确病理类型和病理分级以指导治疗、改善预后。

Abstract:

Objective：To investigate the clinical presentation and the pathological pattern of renal biopsy patients as well as their re－lations. Methods：The clinical and pathological data collected from the patients（≥14 years of age） with renal biopsy from January 2008 to December 2016 in the First Affiliated Hospital of Chongqing Medical University and analyzed the pathological patterns ac－cording to gender，age and clinical presentation. Results：Patients of 1773 were recruited in this study，with male and female ratio of 1∶1.13 and average age was （43.24±13.78） years old. ①Primary glomerulonephritis（PGN），secondary glomerulonephritis（SGN），tubulo-interstitial nephropathy（TIN） and hereditary glomeruler diseases（HGD） were accounted for 77.8%，20.8%，1.3% and 0.1%，respectively. The proportion of PGN was higher than other pathological patterns in young，middle-aged and elder groups，but the con－stitute ratio of PGN and SGN in three groups had no statistical significance（P=0.069）. ②IgA nephropathy（IgAN，41.1%） was the most common PGD，followed by mesangial proliferative glomerulonephritis（MsPGN，22.5%） and membranous nephropathy（MN，14.6%）. The top 3 pathological patterns of SGD were 1upus nephritis（LN，36.4%），Henoch-schonlein purpura nephritis（HSPN，20.1%） and HBV-associated glomerulonephritis（HBV-GN，18.5%）. The constitute ratio of PGN’s all pathological patterns had sta－tistically significant differences in the three aged groups（P=0.000）. IgAN was the most common pathological pattern in the young group and the middle-aged group，while MN was the most common pathological pattern in the old group. ③Nephrotic syndrome（40.3%） and chronic glomerulonephritis（34.2%） were the main clinical presentations in PGN. The most common pathological patterns of nephrotic syndrome and chronic glomerulonephritis were MN and IgAN，respectively. ④The constitute ratio of SGN’s all pathological patterns had statistically significant difference in gender（P=0.000）. The proportion of LN in woman was higher than that in man. The proportion of HSPN，HBV-GN and diabetic nephropathy（DN） in man was higher than that in woman. ⑤The most common pathological grading of LN and HSPN was Ⅳand ⅢB，respectively，and the most common pathological pattern of HBV-GN was MsPGN. Conclusion：The pathological pattern of nephropathy has some relations with age，gender and clinical presentation，but don’t form a regular correspondence. Therefore，nephropathy patients should not just limit to clinical diagnosis，but also should finish renal biopsy to make pathological pattern and pathological grading clearly，which can guide treatment and improve prognosis.