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中国儿童的经活检证实的肾小球疾病谱:全国范围的横断面调查

Clin J Am Soc Nephrol. 2018 Jun 18. pii:CJN.11461017. doi: 10.2215/CJN.11461017. [Epub ahead of print]

中国儿童的经活检证实的肾小球疾病谱:全国范围的横断面调查

The Spectrum of Biopsy-Proven Glomerular Diseases among Children in China: A National, Cross-Sectional Survey.

 

背景和目标:

对活检证实的儿童肾小球疾病谱的高质量流行病学数据有限。本研究旨在确定在中国的活检证实的小儿肾小球疾病的特征和变化趋势。

研究设计:

我们之前进行了全国范围的肾活检调查,包括了2004年1月至2014年12月的11年期间的71,151名患者,其中包括了本次研究的来自中国115家医院的7962名18岁以下的有活检证实肾小球疾病的儿童。人口统计学和临床资料从转诊记录和病理报告中获取。对儿童肾小球疾病的组成与其临床相关资料(性别、年龄组、地区)等进行相关性分析。同时研究了此期间常见肾小球疾病谱的变化。

结果:

  1. 肾病综合征(50%)是儿童肾活检最常见的指征。

  2. 微小病变是最常见的原发性肾小球疾病(29%),其次是IgA 肾病(17%)。

  3. 过敏性紫癜肾炎(13%)和狼疮性肾炎(9%)是最常见的继发性肾小球疾病。

  4. 男孩(38%)微小病变的比例显著高于女孩(13%),而女孩(20%)狼疮肾炎比男孩(3%)更为常见。

  5. 紫癜性肾炎(23%)是幼儿(0-12岁)的主要病理模式,而微小病变(33%)是青少年(13-18岁)最常见的肾小球病。

  6. 不同性别和年龄组的临床病理学相关性略有不同。

  7. 在此研究周期内,微小病变、紫癜性肾炎和膜性肾病的比例增加,同时FSGS比例下降。

结论:

2004年至2014年间,中国儿童肾小球疾病谱存在不同性别、年龄组和地区之间的差异,且发生了显著的疾病谱变化。


Clin J Am Soc Nephrol. 2018 Jun 18. pii:CJN.11461017. doi: 10.2215/CJN.11461017. [Epub ahead of print]

The Spectrum of Biopsy-Proven Glomerular Diseases among Children in China: A National, Cross-Sectional Survey.

Nie S, He W, Huang T, Liu D, Wang G, Geng J,Chen N, Xu G, Zhang P, Luo Y, Nie J, Xu X, Hou FF.

 

Abstract

BACKGROUND AND OBJECTIVES:

High-quality epidemiologic data on the spectrum of biopsy-proven glomerular diseases among children are limited. This study aimed to determine the profile of and temporal change in biopsy-proven pediatric glomerular diseases in China.

 

DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS:

We previously conducted a nationwide kidney biopsy survey including 71,151 patients over an 11-year period from January 2004 to December 2014. A total of 7962 children younger than 18 years old from115 hospitals across China with biopsy-proven glomerular diseases were includedin this study. The demographic and clinical variables were extracted from referral records and pathology reports. The composition of pediatric glomerular diseases and clinicopathologic correlations in different sexes, age groups, and regions were assessed. The changing patterns of common glomerulopathies overthe study period were examined.

 

RESULTS:

Nephrotic syndrome (50%) was the most frequent indication for kidney biopsy in children. Minimal change disease was the most common primary glomerular disease (29%) followed by IgA nephropathy(17%). Henoch-Schonlein purpura nephritis (13%) and lupus nephritis (9%) werethe most common secondary glomerular diseases. The proportion of minimal change disease was significant higher in boys (38%) than in girls (13%), whereas lupus nephritis was more prevalent in girls (20%) than in boys (3%). Purpura nephritis (23%) was the major pathologic pattern in younger children (0-12 years old), whereas minimal change disease (33%) was the most commonglomerulopathy in adolescents (13-18 years old). The clinicopathologic correlations were slightly different between sexes and age groups. We observed increases inthe proportions of minimal change disease, purpura nephritis, and membranous nephropathy over the study period that were contemporaneous with a fall in theproportion of FSGS.

 

CONCLUSIONS:

The spectrum of glomerular diseases among children varied across sexes, age groups, and regions and changed substantially from 2004 to 2014 in China.

 

Copyright © 2018 by the American Society of Nephrology.



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