儿童原发性IgA肾病临床病理特征及预后分析  

Clinicopathologic characteristics and prognosis of primary IgA nephropathy in children

作　　者：景红[1] 何艳燕[1] 宋红梅[1] 金晔[2] 魏珉[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院儿科,北京100730 [2]中国医学科学院中国协和医科大学北京协和医院基本外科,北京100730

出　　处：《临床儿科杂志》2007年第4期263-266,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童原发性IgA肾病(IgAN)的临床、病理特征及预后。方法对近11年确诊为原发性IgAN的81例患儿进行临床病理分析、疗效观察及随防。结果以孤立性血尿和持续性血尿、蛋白尿最多见(各33.3%),其次为肾病综合征和慢性肾炎综合征。病理分级以Ⅲ级多见(53.1%),其次为Ⅱ级和Ⅳ级。免疫病理分型IgA单独沉积最多见(75.3%)。临床表现类型与肾脏病理分级存在线性关联,伴有蛋白尿者病理改变较重。随访73例,平均随访27个月,66例(90.4%)肾功能正常,蛋白尿<1g/24h。结论儿童原发性IgAN的临床表现与病理特征存在一定程度关联,临床表现为肾病及肾炎综合征者病理损害较重,早期予以规律有效治疗,近期疗效好。Objectives To explore the clinical manifestations, pathological features, and prognosis of primary IgA nephropathy （IgAN） in children. Methods The clinical manifestations and pathological features were analyzed in 81 children with IgAN. Effect of treatment was assessed in individual cases through 0.5 - 84 month follow-up. Results Simple hematuria and hematuria combined with proteinuria were the most common clinical manifestation （33.3%）, followed by nephrotic syndrome （21.0%） and chronic nephritic syndrome （4.9%） . Pathological analysis showed that Grade Ⅲ nephropathy was the most common （53.1%）, followed by Grade Ⅱ （30.9%） and Grade Ⅳ （12.3%） . The deposition of solo IgA in the glomeruli was the most common （75.3%）, followed by IgA ＋ IgM ＋ IgG （＋C3） deposition （17.3%） and IgA＋IgM （＋C3） deposition （7.4%） . The severity of glomerular lesion was significantly correlated with clinical manifes- tations （X2 = 6.769, P = 0.034） . During the follow- up （mean duration of 27 months）, 66 out of 73 children （90.4%） had normal renal function and decreased excretion of protein in urine （〈 1 g/24 h）. Conclusions The clinical manifesta- tions of primary IgAN in children are correlated with pathological changes. The patients with nephrotic syndrome or nephritic syndrome are more likely to have severe pathological changes. Renal functions will be improved when the the symptoms axe relieved by early treatment.

关 键 词：IGA肾病 肾小球肾炎 病理 临床 儿童 

分 类 号：R726.9[医药卫生—儿科]