温州市成人原发性肾小球疾病病理类型构成比20年演变

摘要

Objective: To investigate the renal pathologic types of adults’ primary glomerular diseases (PGD) including primary nephrotic syndrome (PNS), and the changing spectrum in 20 years in Wenzhou.Meth-ods: Totally 3 392 adult (≥18 years of age) cases of biopsy-proven primary glomerular diseases diagnosed in the period of 2000 to 2013 in the Department of Nephrology of our hospital were retrospectively investigated, the renal pathologic types of all cases were analyzed and another 553 PGD cases diagnosed in the period of 1993 to 1999 in the same department were analyzed as control.Results:①All of the 3 392 cases of PGD patients, the median age was 37 (29, 48)y, male:female ratio=1:1. The leading PGD was IgA nephropathy (IgAN) (accounts for 59.5%), followed by membranous nephropathy (MN) (accounts for 16.5%) and minimal change disease (MCD) (accounts for 12.4%). MN was the most frequent ifnding in early stage of the elderly and elderly patients (accounts for 46.6% totally), whereas in young and middle-aged adults, IgAN was the commonest (accounts for 47.6% and 41.2%, respectively).②Compared with those diagnosed in the period of 1993-1999, the incidence rate of MN was two-fold increased in 2000-2013 (accounts for 16.5% and 7.2%, respectively). Among 1067 cases of PNS diagnosed in 2000-2013, the dominant renal histopathological finding was MN (accounts for 38.7%), followed by MCD (accounts for 38.3%), IgAN (accounts for 13.0%) and focal segmental glomerular sclerosis (FSGS, accounts for 6.2%).Conclusion: IgAN remains the commonest renal pathologic type of PGD which is correspondence with our previous study. MN become predominant among PNS and increases signiif-cantly in recent years. Without the change of indications for renal biopsy, the evolution of renal pathologic types in PGD over the past 20 years is probably related to the actual change of the kidney diseases in Wenzhou.%目的：探讨温州市成人原发性肾小球疾病（PGD），包括原发性肾病综合征（PNS）病理类型分布的流行病学特征。方法：回顾性分析我院肾内科病理室2000-2013年14年间经肾活检诊断的成人（≥18岁） PGD患者3392例（资料完整）的流行病学特点，并与1993-1999年我院肾活检诊断的553例PGD作比较。结果：①2000-2013年间肾活检诊断PGD共3392例，中位年龄为37（29，48）岁，男女比例为1：1。PGD以IgA肾病（IgAN）最多，占59.5%，其次分别为膜性肾病（MN）和微小病变型肾小球疾病（MCD），分别占16.5%和12.4%。IgAN在青年组、中年组分别占47.6%和41.2%；老年前期组和老年组合计以MN最常见，占46.6%。②与1993-1999年肾活检病例比较，2000-2013年PGD中最显著的改变是MN的比率明显提高（从7.2%提高到16.5%）。1067例PNS以MN最常见，占38.7%，其次分别为MCD（占38.3%）、IgAN（占13.0%）和局灶性节段性肾小球硬化症（FSGS）（占6.2%）。结论：近14年来PGD仍以IgAN居首，但MN的比率有明显上升趋势，后者已成为成人PNS最常见的病理类型。在前后两个时期肾活检指征基本未变的情况下，肾活检PGD构成比的演变可能与实际发病率的改变有关。