1562例经皮肾穿刺活检患者的临床及病理分析

摘要

目的：分析因肾脏疾病行经皮肾穿刺活检患者的临床及病理分型。方法选取2006—2012年中国医科大学附属盛京医院肾脏内科住院行经皮肾穿刺活检的辽宁地区患者1562例，回顾性分析患者的临床资料和病理资料。结果1562例经皮肾穿刺活检患者中，原发性肾小球疾病（ PGN）1222例（78.23%），继发性肾小球疾病（SGN）277例（17.73%），肾小管间质性疾病（ TID）44例（2.82%），遗传性肾病11例（0.71%），未分类肾病8例（0.51%）。PGN 中最常见的病理类型为 IgA 肾病475例（38.87%），其次为膜性肾病311例（25.45%）、系膜增生性肾小球肾炎243例（19.89%）；SGN 中最常见的病理类型为过敏性紫癜性肾炎68例（24.55%），其次为狼疮性肾炎45例（16.25%）、糖尿病肾病44例（15.88%）。不同年龄患者肾脏病理检查结果构成比较，差异有统计学意义（P<0.05）；不同性别和年份患者肾脏病理检查结果构成比较，差异无统计学意义（P >0.05）。肾穿刺指征分别为肾病综合征662例（42.38%），肾炎综合征448例（28.68%）、无症状性尿异常223例（14.28%）、急性肾功能不全105例（6.72%）、肉眼血尿59例（3.78%）、慢性肾功能不全53例（3.39%）、其他12例（0.77%）。不同性别患者肾穿刺指征比较，差异无统计学意义（P >0.05）；不同年龄和肾脏病理检查结果患者肾穿刺指征比较，差异有统计学意义（P <0.05）。结论肾穿刺活检患者中，PGN 最常见，其中 IgA 肾病为最常见病理类型，其次为膜性肾病；SGN 以过敏性紫癜性肾炎和狼疮性肾炎多见。PGN 和 SGN 最常见肾穿刺指征为肾病综合征和肾炎综合征，同一种病理类型可以有不同的临床表现。%Objectjve To analyse the clinical and pathological classification of patients who underwent percutaneous renal biopsy in Liaoning. Methods 1 562 patients who underwent percutaneous renal biopsy in Department of Nephrology of Shengjing Hospital Affiliated to China Medical University from 2006 to 2012,were selected as study subjects,their clinical and pathological informations were analyzed retrospectively. Results Among 1 562 patients who underwent percutaneous renal biopsy, 1 222 cases(78. 23% )had primary glomerular disease( PGN),277 cases(17. 73% )had secondary glomerular disease (SGN),44 cases(2. 82% )had renal tubular interstitial disease(TID),11 cases(0. 71% )had hereditary kidney disease, and 8 cases( 0. 51% ) had unclassified kidney disease. IgA nephropathy ( 475 cases,38. 87% ) was the most common pathological type of primary glomerular disease,followed by membranous nephropathy( 311 cases,25. 45% ),mesangial proliferative glomerulonephritis ( 243 cases,19. 89% ) . Purpura nephritis ( 68 cases,24. 55% ) was the most common pathological type of SGN,followed by lupus nephritis(45 cases,16. 25% ),diabetic nephropathy(44 cases,15. 88% ). There was significant difference in constituent of renal pathological type in different ages(P < 0. 05). There was no significant difference in constituent of renal pathological type between male and female and in different years(P > 0. 05). The most common clinical indication of renal biopsy was nephrotic syndrome(662 cases,42. 38% ),followed by nephritis syndrome(448 cases, 28. 68% ),asymptomatic urinary abnormalities( 223 cases,14. 28% ),acute renal insufficiency( 105 cases,6. 72% ), macroscopic haematuria(59 cases,3. 78% ),chronic renal insufficiency(53 cases,3. 39% ),and other abnormalities(12 case,0. 77% ). There was no significant difference in constituent of renal biopsy indication between male and female( P >0. 05). There were significant difference in constituent of renal biopsy indication in different ages and types( P < 0. 05). Conclusjon PGN is the most common disease among patients who undergo percutaneous renal biopsy in Liaoning. IgA nephropathy is the most common pathological type,followed by membranous nephropathy. Purpura nephritis and lupus nephritis are the most common types of SGN. The most common clinical indications of renal biopsy in PGN and SGN are nephrotic syndrome and nephritis syndrome,patients with the same pathological type can have different clinical features.