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目的总结慢性肾衰竭(CRF)并发泌尿系统移行细胞癌(TCC)的临床特点。方法回顾性分析1994年1月至2006年12月在我院首诊的75例CRF并发TCC患者的流行病学特征、临床表现及其与CRF病因间的关系,分别与同期我院首诊的1084例成人非CRF的TCC患者以及3905例成人非TCC的CRF患者进行比较。结果①成人CRF患者中TCC的发生率为1.89%,占我院首诊TCC患者的6.47%;其中22.7%为规律血液透析后发生。②与非CRF的TCC患者比较,CRF并发TCC患者的平均发病年龄与之一致,但女性所占比例显著增高(62.7%vs30.4%,x~2=20.2,P﹤0.001)。CRF并发TCC者中,透析后TCC及非透析TCC的平均发病年龄[(64.4±6.1)岁vs64.0±9.1)岁]及女性比例(62.7%vs82.3%)均无显著性差异。③CRF并发TCC的主要表现为无痛性肉眼血尿(89.3%)。其中上尿路TCC所占比例(60.0%vs22.3%,x~2=51.8,P﹤0.001)及首诊时多中心TCC所占比例(21.3%vs3.1%,x~2=51.9,P﹤0.001)均显著高于非CRF的TCC。④与非TCC的CRF比较,并发TCC的CRF(即CRF并发的TCC)中慢性间质性肾病导致者所占比例显著增高(37.2%vs73.3%,x~2=43.1,P﹤0.001)。但透析和非透析患者比较,该比例无显著性差异(76.5%vs72.4%)。并发TCC的慢性间质性肾病中,以马兜铃酸肾病(38.2%)和慢性肾盂肾炎(30.9%)多见。结论CRF患者中TCC高发。与非CRF的TCC比较,CRF并发的TCC在女性多见,且上尿路及多中心TCC高发;CRF并发TCC与导致CRF的慢性间质性肾病显著相关,且以慢性感染性间质性肾炎和马兜铃酸肾病多见。
Objective To summarize the clinical features of chronic renal failure (CRF) complicated with urinary system transitional cell carcinoma (TCC). Methods The epidemiological characteristics, clinical manifestations and the relationship between CRF and the causes of CRF were analyzed retrospectively in 75 patients with CRF complicated with TCC from January 1994 to December 2006 in our hospital. 1084 adult non-CRF TCC patients and 3905 adult non-TCC CRF patients were compared. Results ① The incidence of TCC in adult CRF patients was 1.89%, accounting for 6.47% of the first TCC patients in our hospital. Among them, 22.7% occurred after regular hemodialysis. ② The average age at onset of CRF complicated with TCC patients was consistent with that of non-CRF TCC patients, but the proportion of women was significantly higher (62.7% vs 30.4%, x ~ 2 = 20.2, P <0.001). Among patients with CRF complicated with TCC, the average age of onset of post-dialysis TCC and non-dialysis TCC [(64.4 ± 6.1) vs64.0 ± 9.1) years and female (62.7% vs82.3%) had no significant difference. ③ CRF complicated with TCC mainly for painless gross hematuria (89.3%). The proportion of TCC in the upper urinary tract (60.0% vs22.3%, x ~ 2 = 51.8, P <0.001) and the proportion of multicenter TCC at the initial diagnosis (21.3% vs3.1%, x2 = 51.9, P <0.001) were significantly higher than non-CRF TCC. ④ Compared with non-TCC CRF, the proportion of chronic interstitial nephropathy in CRF complicated by TCC was significantly higher (37.2% vs73.3%, x ~ 2 = 43.1, P <0.001) . However, there was no significant difference between dialysis and non-dialysis patients (76.5% vs72.4%). Chronic interstitial nephropathy complicated by TCC was more common in aristolochic nephropathy (38.2%) and chronic pyelonephritis (30.9%). Conclusion CRF patients with high incidence of TCC. Compared with non-CRF TCC, CRF concurrent TCC is more common in women, and the upper urinary tract and multicentric TCC high incidence; CRF concurrent TCC CRF associated with chronic interstitial nephropathy was significantly associated with chronic infectious interstitial nephritis And aristolochic acid nephropathy more common.