温州市成人原发性肾小球疾病病理类型构成比20年演变  

The renal pathologic types of adult primary glomerular diseases in Wenzhou:an analysis of evolution in 20 years

作　　者：叶腾[1] 吕吟秋[1] 陈波[1] 李凡凡[1] 陈孝倩[1] 黄朝兴[1] 

机构地区：[1]温州医科大学附属第一医院肾内科,浙江温州325015

出　　处：《温州医学院学报》2015年第8期574-578,共5页Journal of Wenzhou Medical College

摘　　要：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3 392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3 392例,中位年龄为37(29,48)岁,男女比例为1:1。PGD以Ig A肾病(Ig AN)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%。Ig AN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%)。1 067例PNS以MN最常见,占38.7%,其次分别为MCD(占38.3%)、Ig AN(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Ig AN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。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.Methods：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 Ig A nephropathy（Ig AN）（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 finding in early stage of the elderly and elderly patients（accounts for 46.6% totally）,whereas in young and middle-aged adults,Ig AN 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 1 067 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%）,Ig AN（accounts for 13.0%） and focal segmental glomerular sclerosis（FSGS,accounts for 6.2%）.Conclusion：Ig AN remains the commonest renal pathologic type of PGD which is correspondence with our previous study.MN become predominant among PNS and increases significantly 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.

关 键 词：原发性肾小球疾病 病理类型 肾活检 流行病学 

分 类 号：R692.6[医药卫生—泌尿科学]