80岁及以上老年人肾活检的病理诊断特点及并发症分析

摘要

Objective To evaluate the clinico-pathologic presentations and prognosis in the very elderly patients undergoing renal biopsy.Methods The patients who underwent renal biopsy in Nephrology Center of the First Affiliated Hospital of Zhengzhou University were screened from May 2012 to March 2016.All patients were divided into observation group (aged ≥80 years) and control group (aged 65-70 years).The clinico-pathological classifications and prognosis were compared between the two groups.Results Primary glomerulopathy was the most frequent pathologic diagnosis in observation and control groups[20(60.6％) and 64(64.0％),respectively,P=0.726].Among primary glomerulopathy,membranous nephropathy was the most frequent histopathological type[10(50.0％) and 40 (62.5％)] in observation and control groups,respectively,(P =0.320).Among secondary glomerulopathy,the number of patients in observation group were 10 cases (30.3％) and were 13 cases (13.0％) in control group (t=5.194,P＜0.05),with no significant differences between the two groups in amyloid degeneration,ANCA-associated vasculitis,HBV-associated Glomerulonephritis,and nephritis of Schonlein-Henoch purpura.In the very elderly patients with nephrotic syndrome,glomerular minimal change was the most common histological type [7 (30.4％)],followed by membranous nephropathy[6 (26.1％)].Furthermore,there were no side effects of perinephric hematoma,gross hematuria,arteriovenous fistula or other complications.Conclusions The pathological types distribution of patients aged ≥ 80 versus 65-70 years is different.And the renal biopsy is relatively safe and has an important role for the very elderly patients.%目的 通过分析80岁及以上老年人的临床及病理诊断的特点及穿刺后并发症,以期提高对高寿命老年人肾脏疾病的诊断及治疗水平. 方法 回顾分析2012年5月至2016年3月于郑州大学第一附属医院行肾穿刺活检的33例年龄≥80岁患者的临床资料,并与同期行肾穿刺活检的100例年龄为65～70岁患者进行比较. 结果 两组最常见的病理诊断均为原发性肾小球疾病(20例比64例;60.6％比64.0％),膜性肾病为两组原发性肾小球疾病最常见的病理类型(10例比40例;50.0％比62.5％)(t=0.988,P＞0.05).继发性肾小球疾病在80岁及以上患者中所占比例有所升高(10例比13例;30.3％比13.0％)(t=5.194,P＜0.05),淀粉样变性为其最常见的继发性肾小球疾病(4例,40.0％).80岁及以上患者中肾病综合征占69.6％(23例),肾病综合征患者最常见的病理诊断为肾小球微小病变(7例,30.4％),其次为膜性肾病(6例,26.1％).行肾穿刺活检的133例患者中无1例出现肉眼血尿、肾周血肿、动静脉瘘、穿刺部位感染等并发症. 结论 80岁及以上与65～70岁老年人的肾脏病理类型分布有所不同.80岁及以上老年人行肾穿刺活检是较为安全的,且对其肾脏疾病的正确诊断、治疗方法及判断预后具有重要的指导作用.