婴幼儿227例肾穿刺及临床病理学特点  

Renal Biopsy and Clinical Pathological Features in 227 Infants

作　　者：黄丹琳[1] 易著文[1] 党西强[1] 吴小川[1] 何小解[1] 曹艳[1] 莫双红[1] 何庆南[1] 

机构地区：[1]中南大学湘雅二医院小儿肾脏病研究室湖南省小儿肾脏病临床中心,长沙410011

出　　处：《实用儿科临床杂志》2011年第11期862-864,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的分析婴幼儿肾脏疾病临床病理的特点及婴幼儿肾穿刺安全进行的方法和意义。方法对临床诊断为肾脏疾病的227例婴幼儿进行经皮肾穿刺活检,肾脏病理组织分别进行光镜、免疫荧光和电镜观察。光镜标本做苏木精-伊红(HE)、过碘酸雪夫反应(PAS)、六胺银(PASM)和Masson染色,免疫荧光检测其肾组织中的IgG、IgM、IgA、C3、C4、C1q、Fibrin,204例标本同时行电镜检查。结果所有患儿肾穿刺均获成功,术后无明显并发症。有肾穿刺适应证的227例婴幼儿肾脏疾病中最常见的是肾病综合征(38.3%)、孤立性血尿(37.0%)和急性肾炎综合征(9.3%),继发性肾脏疾病相对较少(5.3%)。肾脏病理类型中最常见的是系膜增生性肾小球肾炎(62.6%)、IgA肾病(8.4%)和局灶节段性肾小球硬化(5.7%)。87例肾病综合征病理类型最常见的是系膜增生性肾小球肾炎(50例)、微小病变(11例)和局灶节段性肾小球硬化(9例);84例孤立性血尿病理类型最常见的是系膜增生性肾小球肾炎(68例)和IgA肾病(9例)。结论在不盲目扩大适应证的基础上,安全有效地进行婴幼儿肾穿刺,可以提高婴幼儿肾脏疾病的诊治水平。Objective To analyze the clinical and pathological features of children under 3 years with renal disease,and summarize the methods and significance of renal biopsy in infants.Methods Percutaneous renal biopsy was performed on 227 infants who were diagnosed as kidney diseases.The specimens were divided into 3 parts for light microscope,electron microscope and immunofluorescence examination respectively and processed by hematoxylin-eosin（HE）,periodic acid-schiff（PAS）,periodic acid-sliver methenamine（PASM）,and Masson staining.Immunofluorescence was used to detect the deposition of IgG,IgM,IgA,C3,C4,C1q,and Fibrin in the renal tissues.Altogether 204 of the specimens were examined by electron microscope.Results All the renal biopsy performed successfully.The top three types of clinical manifestation were nephrotic syndrome（38.3%）,isolated hematuria（37.0%） and acute nephritic syndrome（9.3%）.The number of se-condary renal disease was relatively small（5.3%）.The top three types of renal pathology were mesangial proliferative glomerulonephritis（62.6%）,IgA nephropathy（8.4%） and focal segmental glomerulosclerosis（5.7%）.Mesangial proliferative glomerulonephritis（50 cases）,minimal change disease（11 cases） and focal segmental glomerulosclerosis（9 cases） were the top three pathological types of nephrotic syndrome,while mesangial proliferative glomerulonephritis（68 cases） and IgA nephropathy（9 cases） were the leading pathological types of isolated hematuria.Conclusions The level of diagnosis and treatment of kidney disease in infants can be improved by safe and effective renal bio-psy while the blind expansion of indications for infant renal biopsy should be avoided.

关 键 词：肾脏病理 肾穿刺 婴幼儿 

分 类 号：R726.9[医药卫生—儿科]