目的: 分析内蒙古自治区近20年肾脏病理疾病谱的构成及分布变化特征。方法: 收集于2004—2023年间在内蒙古科技大学包头医学院第一附属医院行肾活检患者的临床病理资料,分析肾活检病理类型的构成、占比及变化趋势和临床特征。结果: (1)共纳入肾活检病例2 765例,其中男性1 477例(53.4%),女性1 288例(46.6%),平均年龄(45.1±15.7)岁,且平均年龄呈显著增长。(2)最常见的原发性肾小球疾病(primary glomerulonephritis, PGN)是膜性肾病(31.9%,881例),其次是免疫球蛋白A肾病(immunoglobulin a nephropathy, IgAN)(25.1%,695例)和微小病变肾病(10.7%,296例)。狼疮性肾炎(4.9%,134例)是最常见的继发性肾小球疾病,其次为糖尿病肾病(3.0%)和紫癜性肾炎(2.8%)。(3)膜性肾病和糖尿病肾病的同期占比呈上升趋势(P＜0.05),而IgAN同期占比下降(P=0.043),且2014年后IgA肾病同期占比低于膜性肾病。结论: 近20年内蒙古地区肾活检病理疾病谱发生显著变迁,自2014年后,膜性肾病已超过IgAN成为最常见的原发性肾小球疾病,另外,糖尿病肾病是增长幅度最大的继发性肾小球疾病。
Objective: To analyze the composition and distribution characteristics of renal pathological disease spectrum in Inner Mongolia Autonomous Region in recent 20 years. Methods: The clinicopathological data of patients who underwent renal biopsy in the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from 2004 to 2023 were collected, and the composition, proportion, change trend and clinical characteristics of renal biopsy pathological types were analyzed. Results: (1)A total of 2 765 renal biopsy cases were included, including 1 477 males (53.4%) and 1 288 females (46.6%).The average age was (45.1±15.7) years old, and the average age increased significantly. (2) The most common primary glomerular disease was membranous nephropathy (31.9%, 881 cases), followed by IgA nephropathy (25.1%, 695 cases) and minimal change nephropathy (10.7%, 296 cases), while the most common secondary glomerular disease was lupus nephritis (4.9%, 134 cases), followed by diabetic nephropathy (3.0%) and purpuric nephritis (2.8%). (3)The proportion of membranous nephropathy and diabetic nephropathy increased significantly in the same period (P＜0.05),while the proportion of IgA nephropathy decreased significantly in the same period (P=0.043), and the proportion of IgA nephropathy in the same period was lower than that of membranous nephropathy after 2014. Conclusion: In the past 20 years, the pathological spectrum of renal biopsy in Inner Mongolia has changed significantly. Since 2014, membranous nephropathy has surpassed IgAN as the most common primary glomerular disease. In addition, diabetic nephropathy is the secondary glomerular disease with the largest growth rate.
[1] Zhang L, Wang F, Wang L, et al.Prevalence of chronic kidney disease in China: a cross-sectional survey[J].The Lancet, 2012, 379(9818): 815-822.
[2] Xu X, Wang G, Chen N, et al.Long-term exposure to air pollution and increased risk of membranous nephropathy in China[J].J Am Soc Nephrol, 2016, 27(12): 3739-3746.
[3] Han Q, Xu H, Li L, et al.Demographic distribution analysis of different glomerular diseases in Southwest China from 2008 to 2022[J].Int Urol Nephrol, 2024, 56(6): 2011-2020.
[4] 邹万忠.肾活检病理诊断标准指导意见[J].中华肾脏病杂志, 2001, 17(4): 270-275.
[5] 左金巾, 肖阳平, 卢登勇, 等.广西壮族自治区1304例肾活检病理资料流行病学特征[J].实用中医内科杂志, 2024, 38(1): 34-36, 148.
[6] 陶晓蕾.山东省近十年6841例肾小球疾病病理类型及流行病学研究[D].济南: 山东大学, 2016.
[7] 王莹莹, 王文革, 邓蓉蓉, 等.甘肃省1828例肾活检病理资料及流行病学特点[J].中华肾脏病杂志, 2019, 35(3): 212-214.
[8] Nie P, Chen R, Luo M, et al.Clinical and pathological analysis of 4910 patients who received renal biopsies at a single center in Northeast China[J].International BR, 2019, 2019: 1-9.
[9] Zhang XD, Cui Z, Zhao MH.The genetic and environmental factors of primary membranous nephropathy:an overview from China[J].Kidney Dis, 2018, 4(2): 65-73.
[10] 苏晨皓, 赵瑛瑛, 王建生, 等.河南省单中心15年间肾活检疾病谱的变迁[J].中国中西医结合肾病杂志, 2021, 22(12): 1061-1063.
[11] 朱慧娴, 周敏林, 侯金花, 等.肾脏疾病谱的变迁:基于2003~2014年中国单中心40759例肾活检病理诊断分析[J].肾脏病与透析肾移植杂志, 2017, 26(2): 101-107.
[12] 詹媛, 卢超航, 花美玲, 等.江西省单中心4314例肾活检临床病理与流行病学分析[J].实用临床医学(江西), 2022, 23(6): 103-107.
[13] 谢姗, 王娟, 江肖, 等.肾活检1912例病理疾病谱与临床诊断相关性分析[J].临床与实验病理学杂志, 2020, 36(12): 1452-1455.
[14] 司仪峰, 董睿, 孙婧, 等.2012-2021年单中心2087例经皮肾穿刺活检患者病理类型分布特点[J].山东医药, 2022, 62(16): 29-33.
[15] Chiu HF, Chen HC, Lu KC, et al.Distribution of glomerular diseases in Taiwan: preliminary report of national renal biopsy registry-publication on behalf of Taiwan society of nephrology[J].BMC Nephrology, 2018, 19(1): 6.
[16] 刘华玉, 王艳, 郭晓燕, 等.2008-2019年宁夏地区肾脏疾病谱演变特征的单中心分析 [J].中华肾脏病杂志, 2022, 38(11): 945-952.
[17] Xu Y.Prevalence and control of diabetes in Chinese adults[J].Jama, 2013, 310(9): 948-959.
[18] Zhang L, Long J, Jiang W, et al.Trends in chronic kidney disease in China[J].N Engl J Med, 2016, 375(9): 905-906.
