单中心自体肾经皮肾穿刺活检临床病理特点的10年总结

目的 回顾性分析单中心10年间成人肾活检资料的流行病学、临床特征和病理类型的分布特点，比较分析不同时期肾活检病理诊断谱的变化情况，初步探讨10年间肾活检流行病学特点的变化。方法 选择2007年1月至2016年12月在我科行肾穿刺活检的15岁及以上的病例，根据时间分为2007—2010年（前期组）、2011—2013年（中期组）和2014—2016年（近期组） 3个时间组，根据年龄分为15~39岁组、40~64岁组和65岁及以上组。收集并采用SPSS 18.0软件分析所有患者的临床病理资料。结果 共入选1 786例临床病理资料完整的肾活检病例。男性973例，女性813例，中位年龄42（15~88）岁。原发性肾小球疾病1 548例，其中IgA肾病最常见，占所有病例的29.1%（520/1 786），微小病变肾病占17.3%（309/1 786），膜性肾病占17.0%（304/1 786）。继发性肾脏疾病238例，其中最常见的为狼疮性肾炎，占所有肾活检病例的3.4%（61/1 786），其次为糖尿病肾病（2.9%，51/1 786）和紫癜性肾炎（2.2%，39/1 786）。3个时期组患者性别、年龄差异无统计学意义；中期组（90/547，16.5%）和近期组（148/555，26.7%）膜性肾病比例高于前期组（66/684，9.6%；P<0.01）。所有病例的临床表现以肾炎综合征最常见（812/1 786，45.5%），肾病综合征次之（688/1 786，38.5%）。15~39岁组以肾病综合征为临床表现的病例中最常见的为微小病变肾病（122/295，41.4%），40~64岁组和65岁及以上组最常见的为膜性肾病（122/312，39.1%；36/81，44.4%）。15~39岁组和40~64岁组肾炎综合征最常见的病理诊断均为IgA肾病（227/403，56.3%；144/381，37.8%），65岁及以上组为膜性肾病（9/28，32.1%）。结论 IgA肾病是最常见的肾小球疾病，近年来膜性肾病的发病率有显著升高的趋势，值得关注。IgA肾病是中青年肾炎综合征病例最常见的病理诊断，膜性肾病是中老年肾病综合征病例最常见的病理诊断。
Objective To analyze the epidemiological changes, clinical features and disease patterns of 10-year renal biopsy series in our center and to compare the changes of pathological diagnosis spectrum of renal biopsy, so as to explore the trend of epidemiological characteristics of renal biopsy across ten years. Methods From January 2007 to December 2016, 1 786 patients (aged ≥18 years) undergoing percutaneous renal biopsy were involved and divided into 3 period groups according to the date of biopsy, earlier group (2007-2010), mid-term group (2011-2013) and recent group (2014-2016). The patients were also divided into 3 age groups (15-39 years, 40-64 years and ≥65 years). The clinical and pathological data of all patients were collected, and than statistical analysis was performed by SPSS 18.0 software. Results A total of 1 786 cases with complete clinical data were enrolled, of which 973 were male and 813 were female, with a median age of 42 years (range 15-88 years). There were 1 548 patients with primary glomerular disease, with IgA nephropathy (IgAN) being the most common one, accounting for 29.1% (520/1 786), 17.3% (309/1 786) having minimal change disease (MCD), and 17.0%(304/1 786) having membranous nephropathy (MN). Totally 238 patients had secondary renal disease, of which lupus nephritis was the most common one, accounting for 3.4% (61/1 786), followed by diabetic nephropathy (2.9%, 51/1786) and Henoch-Schnlein purpura nephritis (2.2% 39/1 786). There were no significant differences in gender or age between three period groups. Compared with the earlier group (66/684, 9.6%), the proportions of MN in the midrtem group