老年肾脏病患者临床及病理特征分析  

Analysis for clinical and pathological features of elderly patients with kidney diseases

作　　者：任姜汶 张小明 戴欢子[2] 张建国[2] 李开龙[2] 何娅妮[2] 林利容[2] Ren Jiangwen;Zhang Xiaoming;Dai Huanzi;Zhang Jianguo;Li Kailong;He Yini;Lin Lirong(Department of Nephrology,Jiulongpo District People's Hospital,Chongqing 400000;Department of Nephrology,Institute of Field Surgery,Daping Hospital,Third Military Medical University,Chongqing 400042,China)

机构地区：[1]重庆市九龙坡区人民医院肾内科,400000 [2]第三军医大学大坪医院野战外科研究所肾内科,重庆400042

出　　处：《中华肾病研究电子杂志》2018年第4期163-166,共4页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家科技支撑计划课题(2015BAI12B06;2013BAI09B05)

摘　　要：目的分析老年(年龄≥60岁)肾脏病患者临床及肾脏病理特点。方法收集2010年1月至2016年12月在我科行肾穿刺活检的老年患者742例,对其性别、年龄、原发性疾病、肾脏病理类型及肾穿刺后并发症进行回顾性分析。以卡方检验比较老年患者与青年患者肾活检并发症的发生率,数据采用SPSS 19.0统计学软件处理。结果 (1)742例老年患者,年龄60～88岁,平均年龄(72.7±11.3)岁;60～74岁637(85.8%),75～88岁105例(14.2%)。男性426例(57.4%)。(2)患高血压者331例(44.6%);贫血272例(36.7%);高尿酸血症199例(26.8%);低蛋白血症257例(34.6%)。CKD1～5期比例分别为27.4%、33.8%、29.8%、7.1%、1.9%。(3)与同期行肾活检年龄≤60岁患者比较,老年患者肾穿刺术后肾周大血肿、需要输血、需行肾动脉栓塞等严重出血并发症的风险无统计学差异(χ~2=0.457、0.108、0.199,P>0.05)。(4)742例老年患者中,原发性肾小球疾病390例(52.6%),继发性肾小球疾病268例(36.1%),肾小管间质疾病72例(9.7%),其他12例(1.6%)。原发性肾脏疾病以膜性肾病和系膜增生性肾小球肾炎最为常见,分别为30.4%和17.3%;继发性肾脏病中糖尿病肾病占21.3%、高血压肾损害和肿瘤相关性肾损害分别为12.3%和11.9%。结论老年肾脏病患者高血压、贫血、高尿酸血症发生率高。原发性肾脏病以膜性肾病为多见,继发性肾脏病以糖尿病肾病、肿瘤相关肾损害最为常见。对于老年肾脏病患者均应结合临床,筛查继发病因。对于无肾穿禁忌证的老年肾脏病患者,应积极行肾活检应明确病理类型指导治疗、判断预后。Objective To analyze the clinical and renal pathological features of over-60-year-old patients with kidney diseases.Methods A total of 742 elderly patients diagnosed with the renal biopsy from January 2010 to December 2016 were retrospectively analyzed for the gender,age,primary disease,and renal pathology types.Chi-square test was used to compare the incidence of renal biopsy complications between elderly and young patients,and the data were treated with SPSS 19.0 statistical software.Results ① There were altogether 742 elderly patients,who aged 60-88 years,with an average age of (72.7 ± 11.3) years,among whom 637 patients (85.8%) aged 60-74 years,and 105 cases (14.2%) aged 75-88 years,with 426 males (57.4%).② Between the less-than-60-year-old patients diagnosed with the renal biopsy during the same period of time,and the over-60-year-old patients,there were no statistically significant differences in the risk of severe bleeding complications including perirenal big hematoma,blood transfusion requirement,and renal artery embolization (χ^2 =0.457,0.108,0.199,respectively,all P >0.05).③ There were 331 cases with hypertension (44.6%),272 cases with anemia (36.7%),199 cases with hyperuricemia (26.8%),and 257 cases with hypoproteinemia (34.6%).The proportions of patients with CKD stages 1-5 were 27.4%,33.8%,29.8%,7.1%,and 1.9%,respectively.④ Among the 742 elderly patients,there were 390 cases with primary glomerular diseases (52.6%),268 cases with secondary glomerular diseases (36.1%),72 cases with tubulointerstitial diseases (9.7%),and 12 cases with other diseases (1.6%).Membranous nephropathy (30.4%) and mesangial proliferative glomerulonephritis (17.3%) were the most common among the primary kidney diseases,while among the secondary kidney diseases,diabetic nephropathy accounted for 21.3%,hypertensive kidney damage 12.3%,and tumor-related kidney damage 11.9%.Conclusions Hypertension,anemia,and hyperuricemia are the most common in elderly patients with kidney diseases.Membranous nephropathy predominated t

关 键 词：老年 肾脏疾病 病理分型 临床表现 

分 类 号：R692[医药卫生—泌尿科学]