沂蒙山区成年人肾小球疾病临床病理研究

目的了解沂蒙山区肾小球疾病的流行病学特点及病理类型与临床表现间的关系。方法回顾性分析814例肾小球疾病患者的性别、年龄、病理类型及临床表现，所得资料进行统计学处理。结果本组患者男性占原发性肾小球疾病的67．2％，继发性肾小球疾病的36．2％，小管间质病变的59％，终末期肾脏疾病的72％。狼疮性肾炎(LN)以女性居多(86．7％)，余均为男性，占多数。肾小球疾病的高发年龄为20～39岁，其中IgA肾病(IgAN)、系膜增生型(MsPGN)、局灶阶段硬化型(FSGS)、IgM肾病(IgMN)、膜增生型(MPGN)、LN、慢性肾炎(CREGN)和抗GBM肾炎最多见于20～29岁。EnPGN型、紫癜型肾炎(HSPN)高发年龄为13～19岁，膜性肾病(MN)为30～49岁，骨髓瘤和血管炎为40～49岁，糖尿病肾病(DN)和淀粉样变性为50～59岁。本组患者最常见的临床表现为尿检异常(38．2％)，依次为肾病综合征(NS)(25．4％)，肉眼血尿型(16．4％)、慢性肾衰(CRF)(8．1％)、急性肾衰(ARF)(6，4％)、高血压型(3．2％)、急性肾炎综合征(ANS)(1．4％)、急进性肾炎综合征(RPGN)(0．9％)。NS患者最常见的病理类型为MsPGN(34．3％)和MN(14、0％)。尿检异常最常见于IgAN(30．1％)和MsPGN(28．0％)，急性肾炎综合征(ANS)主要为EnPGN(78．4％)，ARF为急性间质性肾炎(28．2％)和急性肾小管坏死(14．5％)，RPGN为新月体肾炎(62．1％)。结论原发性肾小球疾病中男性青壮年为高发人群，尿检异常是最常见的临床表现，沂蒙山区病人有自己的分布特点。

CLINICAL PATHOLOGICAL RESEARCH ON ADULT GLOMERULOPATHY IN YIMENGSHAN MOUNTAIN AREA

Objective To explore the relationship between the epidemiological characters,pathological types and clinical expressions of glomerulopathy in Yimengshan mountain area.Methods The sex,age,pathological type and clinical expressions of patients with glomerulopathy in 814 cases were regressively and statistically analyzed.Results Male patients accounted for 67.2% of all cases of primary glomeerulopathy,36.2% of all cases of secondary glomerulopathy,59% of all cases of tubular interstitial lesion and 72% of all cases of terminal kidney disease.Female patients accounted for 86.7% of all cases of lupus glomerulonephritis.The age of patients ranged from 20 to 39.The attack age of IgA nephrosis(IgAN),mesenteric proliferative nephrosis,focal phase sclerotic nephrosis,IgM nephrosis,membranous proliferative nephrosis,Lupus nephrosis,chronic nephrosis and anti-GBM nephritis mostly ranged from 20 to 29.The high-incidence ages of patients with HSPN purpuric nephritis,membranous nephosis,myeloma and vasculitis,and diabetic nephrosis were 13-19,30-49,4049 and 50-59 respectively.The clinical expressions were mainly urinoscopic abnormality (38.%),nephrotic syndrome (25.4%),macroscopic hematuria in naked eyes(16.4%),chronic renal failure(8.1%) acute renal failure (6.4%),hypertensive nephritic syndrome (3.2%),acute nephritic syndrome (1.4%) and rapid progressing clomerulonephritis (0.9%).Membranous proliferative lesion(34.3%) and membranous nephrosis(14%) were of the common patholgic types.Urinoscopic abnormality mainly occurred in patients with IgAN (30.1%) and MsPGN(28.0%).EnPGN(78.4%) was the main acute nephritic syndrome.Acute interstitial nephritis(28.2%) and acute renal tubular necrosis were the main acute renal failures.Crescent necrosis(62.1%) was the main rapidly progressing glomerulonephritis.Conclusion Primary glomerulopathy mainly occur in young and adult males.The main clinical manifestation is urinary abnormalty.The patients in yimenshan area are characterized by their own distribution characteristics.