肾脏疾病谱的变迁:基于2003～2014年中国单中心40759例肾活检病理诊断分析

摘要

Objective:To investigate the distribution and evolution trend of biopsy proven kidney disease.Methodology:Cases in the Renal Biopsy Registry of National Clinical Research Centre of Kidney Diseases in Jinling Hospital from 1st January 2003 to 3st December 2014 were enrolled.We analyzed the distribution and compared with data from 1979 to 2002.Results:In total,40 759 cases of renal biopsy were analyzed.The proportion of patients over 60 years mounted up from 5.60％ to 9.89％.The comparison of spectrun in 1979-2002 and 2003-2014 showed that primary glomerulonephritis(PGN)decreased while secondary glomerulonephritis(SGN) increased.IgA nephropathy(IgAN) was the most common type of PGN.The proportion of MN in PGN was roughly double that of MN in 1979～2002,and the biggest increase was in 14～24 years group.Among SGN there were immune-mediated diseases (59.20％) and tumor-associated or metabolic diseases (37.09％).The proportion of tumor-associated or metabolic diseases associated SGN such as DN,renal amyloidosis,hypertensive nephrosclerosis and monoclonal immunoglobulin deposition disease (MIDD) in SGN rose.Condusion:PGN remained the predominant kidney disease in China,among which IgAN was the most common type.The proportion of MN increased significantly,especially in adolescent patients.The proportion of DN,renal amyloidosis,hypertensive nephrosclerosis and MIDD in SGN rose.The changing spectrun may provide reference and basis for clinical diagnosis,prevention and epidemiological survey.%目的:分析近12年来肾脏疾病谱的构成特征及其变化. 方法:本研究纳入南京总医院国家肾脏疾病临床医学研究中心肾活检注册登记系统中2003-01-01至2014-12-31行肾穿刺活检病例,分析肾脏疾病类型的分布特征,并与1979～2002年的研究数据进行比较. 结果:研究共纳入肾穿刺活检病例40 759例,≥60岁肾活检比例从5.60％增至9.89％.与1979～2002年肾脏疾病谱相比,原发性肾小球肾炎(PGN)比例下降,继发性肾小球肾炎(SGN)比例上升.PGN中以IgA肾病(IgAN)最常见;膜性肾病(MN)比例较1979～ 2002年增长近1倍,且2003～2014年间14～24岁年龄段增幅最大.SGN主要包括免疫介导疾病(59.20％)和肿瘤代谢性疾病(37.09％),糖尿病肾病(DN)、肾淀粉样变性、高血压肾损害和单克隆免疫球蛋白沉积病(MIDD)等肿瘤代谢性疾病的比例呈明显上升趋势. 结论:PGN仍是我国肾脏疾病的主体,以IgAN最常见,MN比例明显升高,在青少年患者中增幅最大.DN、高血压肾损害、肾淀粉样变性和MIDD等肿瘤代谢性SGN均有增长趋势.肾脏疾病谱的这些变化特点将为临床诊断、预防及流行病学研究提供参考依据.