基层医院开展肾活检113例临床与病理分析  

Clinical and Pathological Analysis of 113 Cases with Renal Biopsy Data in Basic Hospitals

作　　者：张文意[1] 钟鸿斌[2] 余英豪[3] 洪本林 金永恩 郑全林[2] 郑自力[2] 贺永湘 

机构地区：[1]福建省石狮市医院肾内科,福建省泉州市362700 [2]福建省晋江市医院肾内科,福建省泉州市362200 [3]南京军区福州总医院病理科,福州市350025 [4]福建省石狮市医院彩超室,福建省泉州市362700

出　　处：《中华全科医学》2013年第5期725-727,共3页Chinese Journal of General Practice

摘　　要：目的总结基层医院开展肾活检的经验,探讨基层医院开展肾活检的价值。方法对113例肾活检病例资料的临床诊断和病理特点进行回顾性分析,并对肾活检的安全性进行分析。结果原发性肾小球疾病76例(67.26%),以IgA肾病(IgAN)和系膜增生性肾小球肾炎(MsPGN)多见,分别占35.53%和32.89%;继发性肾小球疾病32例(28.32%),以狼疮性肾炎(LN)最多见(46.88%),其次为不典型膜性肾病(MN)(25.0%)和乙型肝炎病毒相关性肾炎(HBV-DN)(21.88%);小管间质性疾病5例(4.42%)。通过肾活检修正诊断13例,修正诊断率11.50%,其中3例改变了原有的治疗方案,治疗方案修正率达23.08%。肾活检并发症:肉眼血尿1例(0.88%),肾包膜下血肿2例(1.77%),腰部酸痛25例(22.12%)。无一例出现危及生命的并发症。结论经皮超声引导下肾穿刺并发症少,风险小,在基层医院容易开展,临床与病理紧密结合,使各种肾病患者得到及时、正确的诊治,明显提高基层医院肾脏病的诊治水平。Objective The aim was to summarize the experience of renal biopsy and to investigate the significance of renal biopsy was carried out in basic hospitals. Methods Clinical diagnosis and pathological features of 113 cases with renal biopsy data and the security of the renal biopsy were retrospectively analysed. Results Primary glumerulonephropathy were 76 cases （67.26%）, which the majority was IgA nephropathy （ IgAN, 35.53 % ） and mesangial proliferative glomerulonephritis （ MsPGN, 32.89% ） ; secondary glumerulonephropathy were 32 cases （28.32%）, lupus nephritis （ LN,46.88% ） was the most common among them,followed by atypical membranous nephropathy （MN, 25.0% ） and hepatitis B virus related nephritis （HBV-DN, 21.88% ） ;tubular and interstitial disease were 5 cases（4.42% ） ;diagnosis of 13 cases（ 11.50% ） were adjusted by renal biopsy, the rate of modified diagnosis was 11.50%, the original treatment of 3 cases among them were changed, the modification rate of the treatment was 23.08%. The complications of renal biopsy as follows ： gross hematuria was 1 case （0.88%）, subcapsubar hematoma were 2 cases （ 1.77% ）, lumbago were 25 cases （22.12 % ）, serious complications did not occurred. Conclusion Complications and risk of renal biopsy by precutaneous ultasonography was low. Renal biopsy was carried out easily in basic hospitals, closely combining clinical to pathological make patients with all kinds of kidney diseases receive diagnosis and treatment timely and correctly, which improved greatly the level of diagnosis and treatment in basic hospitals.

关 键 词：肾活检 肾小球肾炎 诊断 误诊 

分 类 号：R446.8[医药卫生—诊断学] R692[医药卫生—临床医学]