过敏性紫癜性肾炎患儿免疫病理类型与临床、病理的相关性  

Correlations of Immunopathologic Types with Clinical Manifestations and Histological Classifications in Children with Henoch Schonlein Purpura Nephritis

作　　者：程江[1] 宋晓翔[1] 王丽峰[1] 朱雪明[2] 封其华[1] 李晓忠[1] 

机构地区：[1]苏州大学附属儿童医院肾脏科,江苏苏州215003 [2]苏州大学附属儿童医院病理科,江苏苏州215003

出　　处：《实用儿科临床杂志》2009年第22期1746-1748,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童过敏性紫癜性肾炎(HSPN)免疫病理类型与其临床、病理的相关性。方法对2003年2月-2008年12月本院行肾组织活检的62例HSPN患儿的临床分型、病理分级、免疫病理分型进行回顾性分析;根据免疫荧光检查结果,将免疫病理分为5型,并分析不同免疫病理分型的HSPN患儿在临床分型、病理分级上的分布特点。结果临床分型以血尿和蛋白尿型最多见(37.09%);病理分级以Ⅲb级最多见(45.16%);免疫病理分型以IgA加IgG加IgM沉积型最多(37.09%)。不同免疫病理类型的HSPN在临床分型分布上差异无统计学意义(P>0.05);而IgA加IgG加IgM沉积型与其他免疫病理类型在病理分级上比较,其表现为Ⅲb～Ⅵ级的比例较高(P<0.05),有IgM沉积者(IgA加IgM沉积型和IgA加IgG加IgM沉积型)与无IgM沉积者(单纯IgA沉积型及IgA加IgG沉积型)在病理分级上比较,前者表现为Ⅲb～Ⅵ级的比例较高(P<0.05);伴C3沉积的病例Ⅲb～Ⅵ级的比例较无伴C3沉积者高(P<0.05)。结论HSPN的免疫病理类型与临床分型之间无相关性,与其病理分级之间有一定的联系。Objective To explore the relationships among immunopathologic types, clinical manifestations and histological classifications in children with henoch - schonlein purpura nephritis （HSPN）. Methods Sixty - two children with HSPN performed renal biopsy in chil- dren＇s hospital affiliated to Soochow university from Feb. 2003 to Dec. 2008 were analyzed retrospectively in terms of immunopathologic types, clinical manifestations and histological classifications. Five immunopathologic types had been categorized based on the result of immunofluores- cence test, the respective characteristic of clinical manifestations, histological classifications in 5 immunopathologic types were analyzed. Re- suits Among the 62 patients, hematuria associated with proteinunia was the most common type in clinical manifestation, grade IU b and IgA plus IgG plus IgM deposit was the most common type in histological and immunopathologic changes respectively. There was no statistically cor- relation between the clinical manifestations and immunopathologic types （P 〉 0.05 ）. Compared with other immunopathologic types,IgA plus IgG plus IgM deposition type had higher proportion of histological grade Ⅲb～Ⅵ （ P 〈 0.05 ） , and patients with IgA plus IgM or IgA plus IgG plus IgM deposit had higher rate of histological grade as Ⅲb～Ⅵ than those with pure IgA or IgA plus IgG （ P 〈 O. 05 ）. Contrasted to the patients without C3 deposition,those with C3 deposition were inclined to histological grade Ⅲb～Ⅵ （ P 〈 O. 05 ）. Conclusions For children with HSPN,immunopathologic types have some relationships with histological changes, but no correlation is found between immunopathologic types and clinical manifestations in this paper.

关 键 词：过敏性紫癜性肾炎 免疫病理类型 临床表现 病理分级 儿童 

分 类 号：R726.9[医药卫生—儿科]