CAJ | 학술논문

目的：慢性肾病是临床常见和多发病，是导致慢性肾衰的主要原因，而肾活检对肾疾病的诊断、治疗及判断预后有重要的指导意义。文中了解我国西藏高原地区慢性肾病的病理特点与临床表现的关系。方法回顾性分析西藏军区总医院自2011年6月至2013年10月因肾疾病行肾活检的107例患者的性别、年龄、病理类型及临床表现。临床医生根据患者的临床表现、实验室检查以及病理结果综合判断，确定最后诊断。结果所有患者行肾活检时年龄10～66岁，平均（29．8±12．2）岁，男性47例（43．9％）、女性60例（56．1％）、藏族75例（70．1％）、汉族31例（28．9％）、白族1例（1％）。患者中以原发性肾小球肾炎为主，占95．3％，继发性肾小球肾炎仅4．7％。男性占本组原发性肾小球疾病的44．3％，女性占继发性肾小球疾病的100％。原发性肾病则以足细胞病为主，占43．9％，其次为膜性肾病，占18．7％，IgA肾病，占11．2％，局灶节段性肾小球硬化症，占9．3％，膜增殖性肾炎，占5．6％等。患者最常见临床表现为肾病综合征，占69．1％，以下依次是尿检异常，占14．9％，单次肉眼血尿，占3．7％，慢性肾衰，占2．8％。肾病综合征患者最常见的病理类型是足细胞病，占63．5％，膜性肾病，占18．9％、局灶节段性肾小球硬化症，占8．1％，膜增殖性肾炎，占5．4％。结论原发性肾小球肾炎为西藏高原地区最常见的肾小球疾病，其中以足细胞病为多见，继发性肾脏病以过敏紫癜性肾炎多见。
목적：만성신병시림상상견화다발병，시도치만성신쇠적주요원인，이신활검대신질병적진단、치료급판단예후유중요적지도의의。문중료해아국서장고원지구만성신병적병리특점여림상표현적관계。방법회고성분석서장군구총의원자2011년6월지2013년10월인신질병행신활검적107례환자적성별、년령、병리류형급림상표현。림상의생근거환자적림상표현、실험실검사이급병리결과종합판단，학정최후진단。결과소유환자행신활검시년령10～66세，평균（29．8±12．2）세，남성47례（43．9％）、녀성60례（56．1％）、장족75례（70．1％）、한족31례（28．9％）、백족1례（1％）。환자중이원발성신소구신염위주，점95．3％，계발성신소구신염부4．7％。남성점본조원발성신소구질병적44．3％，녀성점계발성신소구질병적100％。원발성신병칙이족세포병위주，점43．9％，기차위막성신병，점18．7％，IgA신병，점11．2％，국조절단성신소구경화증，점9．3％，막증식성신염，점5．6％등。환자최상견림상표현위신병종합정，점69．1％，이하의차시뇨검이상，점14．9％，단차육안혈뇨，점3．7％，만성신쇠，점2．8％。신병종합정환자최상견적병리류형시족세포병，점63．5％，막성신병，점18．9％、국조절단성신소구경화증，점8．1％，막증식성신염，점5．4％。결론원발성신소구신염위서장고원지구최상견적신소구질병，기중이족세포병위다견，계발성신장병이과민자전성신염다견。
[Abstract ] Objective Chronic renal disease,a common and frequent disease,is the most cause inducing chronic renal failure. There is an important guiding significance for renal biopsy in the diagnosis,treatment and prognosis of renal disease.The aim of this study was to analyze the characteristics of renal biopsy and the relation between pathological types and clinical presentation in Tibet. Methods Between June 2011 and December 2013 in General Hospital of Tibetan Military Command, Lhasa, percutaneous renal biopsy were per-formed in 107 renal patients.In this study, the gender, age, pathologic entities, and clinical manifestation were analyzed retrospectively. The final diagnosis was made by the clinical manifestation, laboratory examination,and pathologic results. Results The mean age at renal biopsy was 29.8 ±12.2(10~66)years in 47 male cases (43.9%) and 69 female cases (56.1%).This includes 75 Tibetan cases (70.1%), 31 Han cases (28.9%), and Bai cases (1.0%).The primary glomerular disease was 95.3%and the secondary glomerular disease was 4.7%in the total 107 cases.Fourty-four point three percent of the primary glomerular disease were male cases and 100%of secondary glomerular disease were female cases.The main pathological type of the primary glomerular disease was podocyte nephropathy (43.9%), followed by membranous nephropathy (18.7%), IgA nephropathy (11.2%), focal segmental glomerulosclerosis (9.3%) and mesangiocapillary glomerulonephritis (5.6%).The clinical manifestations of 107 cases were classified as syndrome of nephrotic syn-dromn(69.1%),urinary abnormalities(14.9%),isolated macrographic haematuria (3.7%),chronic renal failure(2.8%).Among the nephrotic syndrome,podocyte disease was 63.5%,membranous glomerulopathy was 18.9%,focal segmental glomeruolsclerosis was 8.1%,and membranoproliferative glomerulonephritis was 5.4%. Conclusion The primary glomerulonephritis was the most common glomerular diseases at high altitude area in Tibet.The most frequent type of pri-mary glomerular nephritis was podocyte disease, and the most frequent type of secondary glomerular nephritis was Henoch-Schonlein purpura glomerulonephritis.