摘要目的 从肾活检病理角度分析2004-2017年儿童肾脏疾病的构成特征及其变化.方法 回顾性收集并分析2004年4月至2017年12月在东部战区总医院就诊的0～18岁肾脏病患儿的临床及病理资料,并与1982年6月至2004年3月本院的1611例0～18岁患儿肾脏病理资料数据进行比较.结果 研究共纳入经肾活检的各种肾脏疾病9925例,男女比例为1,79∶1,原发性肾小球疾病占66.14％,继发性肾小球疾病占28.00％.原发性肾小球疾病前5位依次为:IgA肾病(IgAN,19.11％)、系膜增生性肾小球肾炎(MsPGN,16.07％)、微小病变(MCD,14.20％)、局灶节段性肾小球硬化(FSGS,6.19％)、膜性肾病(MN,4.70％);男性患儿前5位与之相同,依次为IgAN(13.12％)、MsPGN(11.20％)、MCD(10.63％)、FSGS (4.55％)、MN(2.54％);女性患儿为IgAN (5.99％)、MsPGN (4.87％)、MCD (3.57％)、MN (2.16％)、FSGS(1.63％);继发性肾小球疾病前3位为紫癜性肾炎(HSPN,17.74％)、狼疮肾炎(LN,8.23％)、血管炎肾损害(1.82％).在各型肾脏疾病中,除了LN女性患儿比例高于男性外,其余均表现男性患儿比例高于女性;在病例数绝对值方面,HSPN在6～ 13岁儿童男女均居第1位,超过LN;14～ 18岁女性LN、男性IgAN分别病例数最多;女性MN病例数有增长趋势;感染后肾炎高峰年龄为12～ 14岁.在前后资料对比中发现,2004年以后继发性肾小球疾病中HSPN和LN的总占比上升,感染后肾炎的占比较2004年前降低.结论 原发性肾小球疾病仍是我国儿童肾脏病的主要疾病.免疫异常导致的肾小球疾病比例增加,感染后肾炎比例下降.这些儿童肾脏疾病谱的变化可为临床儿科医生对肾脏疾病的诊断、治疗、预防提供参考,为流行病学研究提供中国儿童人群的数据.

abstractsObjective To analyze the spectrum of children's kidney pathology by renal biopsy.Methods The clinical and pathological data of the cases in Jinling Hospital involving the patients younger than 18 years old who received renal biopsy from April 1st,2004 to December 31th,2017 were retrospectively collected,and compared with the renal pathological data of 1611 children aged 0-18 years from June 1982 to March 2004.Results This study included 9925 cases of kidney diseases proven by renal biopsy.The ratio of male to female was 1.79∶ 1.Primary glomerulonephritis (PGN) accounted for 66.14％,and secondary glomerulonephritis (SGN) accounted for 28.00％.Top five of the PGN were IgA nephropathy (IgAN,19.11％),mesangial proliferative glomerulonephritis (MsPGN,16.07％),minimal change disease (MCD,14.20％),focal segmental glomerulosclerosis (FSGS,6.19％)and membranous nephropathy (MN,4.70％) in whole children,IgAN (13.12％),MsPGN (11.20％),MCD (10.63％),FSGS (4.55％) and MN (2.54％) in males,and IgAN (5.99％),MsPGN (4.87％),MCD (3.57％),MN (2.16％) and FSGS (1.63％) in females.Top three of the SGN were Henoch-Schonlein purpura nephritis (HSPN,17.74％),lupus nephritis (LN,8.23％) and vasculitis nephropathy (1.82％).The male was in a dominant position in all kinds of pathologic types than female except LN.HSPN was the most frequent type in adolescents between 6-13 years old.LN was the commonest one in 14-18-year-old girls,while IgAN was the the most common in 14-18-year-old boys.Post infective nephritis was the most popular in 12-14-year-old teenagers.It was also found that MN ascended in female.When compared with the data before 2004,HSPN and LN accounted for a greater proportion in SGN,post infective nephritis displayed a smaller proportion.Conclusions PGN is the mainly kind of glomerular disease as before,and immune disorder related to glomerular diseases increase and post infective nephritis decreases in proportion.This study provides the reference and epidemic data for diagnosis,treatment and prevention of children's renal diseases.