单中心儿童肾活检1579例临床和病理类型分析  

Single centre clinico-pathological analysis of 1 579 renal biopsies in children

作　　者：尹晓玲[1] 邹敏书[1] 王嘉[1] 刘铜林[1] 唐锦辉[1] 仇丽茹[1] 陈瑜[1] 袁惠卿[1] 周建华[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院儿科,武汉430074

出　　处：《中国循证儿科杂志》2012年第6期424-430,共7页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的了解肾穿刺患儿病理特点及其与临床表现的关系,以及疾病谱变迁。方法调取华中科技大学同济医学院附属同济医院儿科1989至2012年行肾活检病例的临床分类和病理学分型资料,依据年龄(<1、～3、～6、～12和～18岁)和性别分组进行构成比的比较和分析,以2001年为时间节点分为2个阶段分析疾病谱的变化趋势。结果 1579例肾活检患儿进入分析,平均肾穿刺年龄(9.3±3.2)岁,男女比例1.92∶1。①肾活检患儿中原发性肾小球疾病949例(60.1%),继发性肾小球疾病493例(31.2%),遗传性肾脏疾病130例(8.2%);原发性肾小球疾病中肾病综合征、单纯血尿、急性肾炎分别占44.8%、26.2%和15.3%;继发性肾小球肾炎中紫癜性肾小球肾炎、HBV相关性肾炎(HBVGN)和狼疮性肾炎(LN)分别占55.4%、22.9%和18.4%;遗传性肾脏疾病中薄基底膜病和Alport综合征分别占50.0%和46.2%。②949例原发性肾小球疾病的病理类型以轻微病变/微小病变(24.8%)、IgA肾病(21.0%)和系膜增生性肾小球肾炎(19.1%)为主;女性新月体性肾小球肾炎构成比显著高于男性。③肾病综合征构成比随年龄增长呈逐渐减少趋势,单纯血尿构成比在～12岁组最高(31.0%),急性肾炎和慢性肾炎构成比随年龄增长呈逐渐增加趋势;HBVGN主要分布于～3岁组(71.4%),构成比随年龄增长而呈下降趋势。LN主要见于～18岁组,溶血尿毒综合征主要分布于～3岁和～6岁组。④原发性肾小球疾病主要病理类型:肾病综合征为微小病变/轻微病变(31.1%),急性肾炎为毛细血管内增生性肾小球肾炎(28.3%),慢性肾炎为硬化性肾炎(59.4%)。⑤2002至2012年肾病综合征、紫癜性肾炎、IgA肾病构成比较1989至2001年显著增高,急性肾炎、HBVGN构成比显著下降。结论肾活检患儿肾小球疾病临床和病理类型与年龄、性别有一定相关性,23年间某些肾小球疾病的构成比发生变化。Objective To investigate the clinical features and pathological characteristics as well as their associations with secular trend of the disease of 1 579 pediatric renal biopsies.Methods The clinical and pathological data were retrospectively analyzed in 1 579 children with renal diseases with biopsy performed from 1989 to 2012 in our hospital. The changes of clinical and pathological type distribution were characterized in every 5 years historically in different age groups （ -1, -3, -6, -12, -18 years） and genders.Results ①The mean age of 1 579 children was （9.3±3.2） years （4 months to 18 years）. The ratio of males to females was 1.92. Primary glomerulonephritis （PGN）, secondary glomerulonephritis （SGN） and inherited nephropathy accounted for 60.1%, 31.2% and 8.3% of the total cases. The PGN and SGN mainly included nephritic syndrome （NS）, isolated hematuria, acute glomerulonephritis（AGN） and Henoch-schonlein purpura nephritis（HSPN）, HBV-associatied glomerulonephritis（HBVGN）, lupus nephritis（LN）, respectively. The pathological classification of PGN mainly included minimal change disease/mild disease （MCD/ML）, IgAN and mesangial proliferative glomerulonephritis（MsPGN）. ②Male patients dominated in NS, HBVGN and Alport syndrome, however, female dominated in isolated hematuria, rapidly progressive glomerulonephritis（RPGN）, LN, ANCA-associated glomerulonephritis and thin basement membrane disease. The proportions of NS, isolated hematuria, AGN, CGN, HBVGN, LN and hemolytic uremic syndrome significantly changed with age. ③The clinical patterns of PGN were significantly correlated with the distribution of pathological types. The main pathological patterns of NS were MCD/ML, IgMN and IgAN. The main pathological patterns of hematuria were MCD/ML, IgAN and MsPGN. The main pathological patterns of hematuria with proteinuria were IgAN and MsPGN. The main pathological patterns of RPGN and chronic glomerulonephritis（CGN） were crescentic glomerulonephritis（CreGN�

关 键 词：原发性肾小球肾炎 继发性肾小球肾炎 肾活检 儿童 

分 类 号：R446.8[医药卫生—诊断学]