小儿狼疮性肾炎41例临床与病理分析  

Clinical and pathological analysis of 41 children with lupus nephritis

作　　者：胡志兰[1] 何小解[1] 党西强[1] 黄丹琳[1] 赵维玲[2] 易著文[1] 

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童肾病专科,长沙410011 [2]深圳市儿童医院肾内科

出　　处：《中华实用儿科临床杂志》2013年第17期1315-1319,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 分析小儿狼疮性肾炎（LN）病理与临床的相关性以及肾小球损害、肾间质损害与肾内血管损害的相关性.方法 选取2008年1月至2012年9月在中南大学湘雅二医院儿科住院确诊为系统性红斑狼疮的基础上行肾穿刺活检并诊断为LN的患儿共41例.收集患儿血、尿、生化等临床资料.依据ISN/RPS2003 LN病理分型标准进行分型.分别对肾小球损害、肾间质损害行半定量积分评价.测量肾内小/细动脉血管壁厚度/血管外径、内膜厚度/血管外径、中膜厚度/血管外径.结果 LN伴随各种临床表现的百分率随病理损害程度加重而呈上升趋势；不同病理分型的各组肾小球损害积分及肾间质损害积分不同（P＜0.05）,且随着病理分型的加重积分更高,即肾小球及肾间质损害更严重.肾小球损害积分与肾间质损害积分呈直线正相关（r =0.959,P＜0.05）.患儿的血管壁厚度/血管外径均超过0.5,提示血管壁均增厚.结论 LN肾内血管损害确实存在,且LN血管损害以内膜的完整性逐渐被破坏及中膜逐渐增厚为特点.Objective To analyze the correlation between clinical characteristics and pathological findings lupus nephritis （LN） in children,together with the correlation of the renal vascular lesion respectively with the glomerular lesion and tubulointerstitial lesion.Methods Forty-one cases of LN in children diagnosed by percutaneous renal biopsy from Jan.2008 to Sep.2012 in Pediatrics of the Second Xiangya Hospital of Central South University were collected.Clinical manifestations and the lab findings of the blood and urine of all the patients were analyzed,and all the frozen sections were evaluated according to the standard of ISN/RPS2003 for LN.The glomerular lesion and tubalointerstitial lesion separately were also evaluated,respectively.The wall thickening/outer diameter ratio,intima thickening/outer diameter ratio and medial thickening/outer diameter ratio of the arterioles were measured.Results The percentage of clinical manifestation with LN increased coupled with the degree of pathological damage.In the different stages of pathological damage,both the glomerular lesion and tubulointerstitial lesion were getting much more serious along with the progressiveness of pathological damage,and what＇s more,they had a positive correlation（r =0.959,P ＜ 0.05）.The wall thickness/outer diameter ratio in all cases was greater than 0.5,in dicating the thickness of vessel wall.Conclusion Renal vascular lesion really existed and is characterized by the progressive loss of integrity of the intima and the medial thickening.

关 键 词：狼疮性肾炎 血管 病理 肾脏 

分 类 号：R725.9[医药卫生—儿科]