上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

儿童肾活检977例病理及临床分析

李玉峰，卫敏江，吴伟岚，陈慧敏，沈 加，董 瑜，金 晶   

  1. 上海交通大学 医学院附属新华医院儿内科， 上海 200092
  • 出版日期:2014-03-28 发布日期:2014-04-02
  • 通讯作者: 卫敏江, 电子信箱: wmj10@126.com。
  • 作者简介:李玉峰（1977—）， 男， 主治医师， 博士; 电子信箱: mieuniversity@hotmail.com。
  • 基金资助:

    国家自然科学基金资助项目（30901737）；上海交通大学医学院附属新华医院“优秀青年医学人才”科研项目

Clinical and pathological analysis of 977 children with renal biopsy

LI Yu-feng, WEI Min-jiang, WU Wei-lan, CHEN Hui-min, SHEN Jia, DONG Yu, JIN Jing   

  1. Department of Pediatrics， Xinhua Hospital, Shanghai Jiao Tong University School of Medicine， Shanghai 200092， China
  • Online:2014-03-28 Published:2014-04-02
  • Supported by:

    National Natural Science Foundation of China, 30901737; Outstanding Young Medical Scholars' Scientific Research Foundation of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

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摘要：

目的 回顾性分析小儿肾脏疾病的病理类型及临床特点。方法 收集977例接受经皮肾活检患儿的病理诊断和临床资料，分析比较原发性肾小球疾病与继发性肾小球疾病的病理类型和临床特征。结果 成功肾活检971例，其中原发性肾小球疾病755例（77.8%），继发性肾小球疾病183例（18.8%），先天性遗传性代谢性肾小球疾病18例（1.9%）。原发性肾小球疾病中，临床诊断前3位依次为孤立性血尿、肾病综合征和迁延性肾小球肾炎；病理类型前3位依次为肾小球轻微病变、局灶节段性肾小球硬化和局灶性肾小球肾炎。继发性肾小球疾病中，临床诊断前3位依次为紫癜性肾炎、乙型肝炎相关性肾小球肾炎和狼疮性肾炎；病理类型前3位依次为系膜增生性肾小球肾炎、肾小球轻微病变和膜性肾病。在18例先天性遗传性代谢性肾脏疾病中,有7例为薄基膜肾病。在临床诊断为孤立性血尿的患儿，肾活检病理类型中肾小球轻微病变所占百分比随患儿年龄的增长逐渐降低（P<0.05），而IgA肾病和局灶性肾小球肾炎所占百分比随患儿年龄的增长逐渐升高（P<0.05）。结论 本组资料中，儿童肾小球疾病以原发性肾小球疾病为主，临床表现和病理类型以血尿和肾小球轻微病变最为常见；小儿继发性肾小球疾病以紫癜性肾炎最为常见，病理类型以系膜增生性肾小球肾炎、肾小球轻微病变和膜性肾病为主；先天性遗传性肾脏疾病中薄基膜肾病最为常见。建议对6岁以上的孤立性血尿患儿行肾穿刺活检术。

关键词: 肾活检, 病理类型, 儿童, 回顾性分析

Abstract:

Objective To retrospectively analyze the pathological categories and clinical characteristics of childhood renal diseases. Methods The pathological diagnoses and clinical data of 977 children with percutaneous renal biopsy were collected and the differences between primary glomerular disease and secondary glomerular disease were analyzed. Results Among 977 patients, 971 renal biopsies were successfully performed. There were 755 (77.8%) cases of primary glomerular disease, 183 (18.8%) cases of secondary glomerular disease, and only 18 (1.9%) cases of heritage glomerular disease. For the primary glomerular disease, the top 3 clinical diagnoses were isolated hematuria, nephritic syndrome, and persistent glomerulonephritis, respectively. The top 3 pathological categories were minor lesion type, focal segmental glomerulosclerosis (FSGS), and focal glomerulonephritis (FGN). For the secondary glomerular disease, purpura nephritis, hepatitis B virus associated nephritis, and lupus nephritis (LN) were the top 3 clinical diagnoses. The top 3 pathological categories were mesangial proliferative glomerulonephritis, minor lesion type, and membranous nephropathy. Among 18 cases of heritage glomerular disease, 7 were thin basement membrane nephropathy (TBMN). For children diagnosed with isolated hematuria, the percentage of minor lesion type decreased with age (P<0.05), while the percentages of FGN and IgAN increased with age (P<0.05). Conclusion The primary glomerulary disease is the main type of children glomerulary diseases. The higher incidence of minor lesions is possibly due to the higher incidence of isolated hematuria. For the secondary glomerulary disease, purpura nephritis is the most common clinical diagnosis and MPG, minor lesion type, and membranous nephropathy are common pathological categories. While TBMN is the most common pathological category of the heritage glomerular disease. The renal biopsy is suggested for children with isolated hematuria whose ages are more than 6 years old.

Key words: renal biopsy, patholgical category, child, retrospective analysis