儿童紫癜性肾炎临床与病理相关性分析  

Relationship between clinical manifestations and renal pathology in children with Henoch-Schonlein purpura nephritis

作　　者：张国珍[1] 吴小川[1] 易红[1] 彭晓杰[1] 党西强[1] 何小解[1] 易著文[1] 

机构地区：[1]中南大学湘雅二医院小儿肾脏病研究室,长沙410011

出　　处：《中国当代儿科杂志》2007年第2期129-132,共4页Chinese Journal of Contemporary Pediatrics

基　　金：湖南省科技厅科技计划项目(06SK-3029-11)

摘　　要：目的通过对95例紫癜性肾炎(HSPN)患儿临床表现及肾脏病理分析,阐明其临床及病理之间的联系。方法对HSPN患儿进行临床分型及病理分级,对其进行综合分析。结果①临床分型以肾病综合征型(27.4%)、蛋白尿+血尿型(24.2%)多见,病理分级以Ⅲb(42.1%)最多见;②尿检正常者可见肾脏病理改变。尿检正常型、孤立性血尿或蛋白尿型以及血尿和蛋白尿型病理改变差异无显著性(P>0.05);③孤立性血尿或蛋白尿型以及血尿和蛋白尿型病例,病程越长病理分级也越重(P<0.05);④免疫复合物沉积以IgA+IgG+IgM(58%)同时存在比例最高;病理分级越重,病程越短,IgA+IgG+IgM比例越高。结论HSPN患儿临床表现为肾病综合征和肾炎型者病理改变相对较重,临床症状与病理不一定平行,尿检正常者病理改变也很明显,病程越长,病理改变呈加重趋势。免疫复合物沉积为IgA+IgG+IgM的病理改变相对较重。Objective This study investigated the clinical manifestations and renal pathological findings of 95 children with Henoch-Schonlein purpura nephritis （HSPN）in order to explore the relationship between clinical manifestations and renal pathology in HSPN. Methods According to clinical manifestations, 95 HSP patients were classified into six clinical groups ： 1 ） normal urine analysis ; 2） isolated hematuria or proteinuria ; 3 ） proteinuria with hematuria ; 4） acute nephritis ; 5） nephrotic syndrome; 6） acute nephritis with over 50 mg/（ kg· d） of proteinuria. The severity of the renal pathological findings was determined based on the classification of the International Study of Kidney Disease （ISKDC）, including grades Ⅰ-Ⅵ The relationship between clinical manifestations and the severity of renal pathological findings was studied. Results Nephrotic syndrome was the most common clinical diagnosis （ 26 cases）, followed by proteinuria with bematuria （ 23 cases）, normal urine analysis （20 cases）, isolated hematuria or proteinuria （ 15 cases）, acute nephritis with over 50 mg/ （kg· d） of proteinuria （7 cases） and acute nephritis （4 cases）. Twenty-five out of 26 patients with nephrotic syndrome had an ISKDC classification of grade Ⅲ-Ⅳ. All of the four patients with acute nephrits had a classification of grade Ⅲb. The 7 cases of acute nephritis with over 50 mg/（kg· d） of proteinuria had a classification of grade Ⅲa-Ⅴ. The 20 patients with normal urine analysis had a classification of grade Ⅱa- Ⅲb. There were no significant differences in ISKDC classification among the patients with normal urine analysis, isolated hematuria or proteinuria, and hematuria plus proteinuria. As the course progressed, the degree of renal pathological changes in patients with isolated hematuria or proteinuria and hematuria plus proteinuria became more serious. Of all the 95 patients, 58% had co-deposition of immunoglobulins A, G and M. The percentage of co-deposition of i

关 键 词：紫癜性 肾炎 临床表现 病理学 儿童 

分 类 号：R726.91[医药卫生—儿科]