近20年肾脏病理谱变化趋势的回顾性分析

目的 通过对近20年肾脏病理类型的回顾性分析,为我国肾脏疾病谱的构成及其演变趋势提供信息.方法 回顾性分析近20年我科因肾脏疾病行肾活检患者4 105例的病理类型,并比较1994年～2003年与2004年～2013年前后10年间肾脏病理类型的变化.病理分型参考WHO1995年肾小球疾病组织学分型方案和2001年在全国肾活检病理诊断研讨会上拟定的肾活检病理诊断标准指导意见,结合临床资料、实验室检查结果、免疫病理及超微结构改变特点明确诊断.结果 本组4 105例肾脏疾病患者行肾活检时的平均年龄（34.5±12.3）岁,男女比例为0.85∶1.本组原发性肾小球疾病者3 410例（占83.0％）,继发性肾小球疾病者516例（占12.6％）,遗传性肾脏疾病者42例（占1.0％）,肾小管间质疾病者76例（占1.9％）,新发现罕见肾脏疾病者10例（占0.2％）,未分类者51例（占1.3％）.原发性肾小球疾病以IgA肾病最为常见1 450例（占42.5％）,最常见的继发性肾脏病是狼疮肾炎254例（占49.2％）.近10年肾活检患者人数明显增加,年龄增高,平均年龄从（31.9±11.2）岁增至（35.1±12.5）岁,40岁以上患者数量明显增多.分析前后10年间各种原发及继发性肾脏病的检出率,证实IgA肾病、膜性肾病、局灶节段性肾小球硬化症、微小病变均增多（均P＜0.01）,而系膜增生性病变、增生硬化性肾小球肾炎、膜增生性肾小球肾炎、硬化性肾小球肾炎则减少（均P＜0.01）.近10年还发现了一些少见的肾脏疾病（如：胶原Ⅲ肾病、纤维性肾小球病、免疫触须样肾小球病、肾小球囊肿病、脂蛋白肾病等）.结论 原发性肾小球疾病仍为我国最常见的肾小球疾病,近10年来,肾脏疾病谱发生了变化,其变化可能与医疗水平的提高和实际发病率的改变有关.

Retrospective analysis of renal pathology variation over the past 20 years

Objective To provide information for kidney disease spectrum composition and evo lution trend by retrospectively analyzing renal pathological types over the past 20 years.Methods Be tween January 1994 and June 2013 in Tongji Hospital （Wuhan,China）,4105 attempts of percutane ous renal biopsy were performed on renal patients.In this report,the pathologic entities were analyzed retrospectively,and the pathologic demography between 1994 2003 and 2004-2013 was compared.Pathological classifications were made according to the WHO criteria of 1995 and Directive opinion of Renal biopsy Diagnostic of 2001.Results The mean age at renal biopsy was 34.5 ± 12.3 （10 76） years in 4105 patients with renal diseases with a male to female ratio of 0.85 ∶ 1,primary glomerular diseases （PGD） accounted for 83.0％ （3410 cases） of the total renal patients,secondary glomerular nephritis （SGN） for 12.6％ （516 cases）,hereditary and congenital renal diseases for 1.0％ （42 cases）,tubu lar interstitial diseases for 1.9％ （76 cases） and recently realized or rare renal diseases for 0.2％ （10 cases）,and unclassified renal diseases for 1.3％ （51 cases） respectively.IgAN was the most frequent pathologic type （1450 cases,42.5％） of PGD.The most frequent type of SGN was lupus nephritis （LN） （254 cases,49.2％）.The number of patients subject to renal biopsy was significantly in creased,the average age increased from （31.9 ± 11.2） to （35.1 ± 12.5） years old,and the number of patients over 60 years old increased significantly （P＜0.01）.An increment of prevalence was found in IgA nephropathy,MN,FSGS,and MCD （P＜0.01）,and a decrement in MsPL,MPGN,PSGN and SGN （P＜0.01） over 2004 2013 as compared with those during 1994 2003.Infrequent renal patholog ical entities were also diagnosed during 2004-2013,including collagen Ⅲ glomerulopathy,fibrillary glomerulopathy,immunotactoid glomerulopathy,glomerulocystic disease,and lipoprotein glomerulop athy.Conclusions Primary glome