儿童紫癜性肾炎167例临床和病理分析  

Analysis of clinical and pathological characteristics in 167 children with Henoch Sch（o）nlein purpura nephritis

作　　者：张建江[1] 史佩佩[1] 付书琴[1] 王淼[1] 窦文杰[1] 田喜艳[1] 

机构地区：[1]郑州大学第一附属医院儿内科,河南省儿童肾脏病临床诊疗中心,河南省高等学校临床医学重点学科开放实验室,450052

出　　处：《中华实用儿科临床杂志》2013年第17期1320-1322,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省科技攻关项目（122102310213）;河南省医学科技攻关计划项目（2011020025）;郑州市科技局科技攻关计划项目（10PTGG380-5）

摘　　要：目的 探讨儿童紫癜性肾炎（HSPN）的临床、肾组织病理特点.方法 回顾性分析2008年1月至2011年12月在郑州大学第一附属医院住院的167例HSPN患儿资料,收集其起病年龄、性别、肾损伤发生时间、临床症状、24 h尿蛋白定量及肾脏病理分级,依24 h尿蛋白定量分为A组（24 h尿蛋白定量＜25 mg/kg）和B组（24h尿蛋白定量≥25 mg/kg）,并将2组资料进行分析.结果 HSPN患儿男女之比为1.8∶1.0,5～10岁占70.7％；肾损伤发现时间1d～5个月,91.6％1个月内发生肾损伤；HSPN患儿临床症状有消化道累及者56例（33.5％）,同时有消化道、关节累及者52例（31.1％）；HSPN患儿病理分级中Ⅰ级8例（4.8％）,Ⅱ级32例（19.2％）,Ⅲ级124例（74.3％）,Ⅳ级3例（1.8％）,未见Ⅴ级及Ⅵ级患儿；24 h尿蛋白定量分组中B组病理分级较A组重,差异有统计学意义（P＜0.05）.结论 过敏性紫癜患儿中男童、累及消化道者应警惕肾脏损伤,尤其是在发病1个月内.HSPN患儿应积极行肾穿刺活检,尤其是当24 h尿蛋白定量≥25 mg/kg时.Objective To investigate the clinical,renal pathological characteristics of Henoch Sch（O）nlein purpura nephritis （HSPN） in children.Methods One hundred and sixty-seven children hospitalized with HSPN from Jan.2008 to Dec.2011 in the First Affiliated Hospital of Zhengzhou University were divided into 2 groups by 24-hour urinary protein quantity：group A with 24-hour urinary protein quantity ＜ 25 mg/kg,group B with 24-hour urinary protein quantity ≥ 25 mg/kg.Age of onset,gender,injury time of kidney,clinical manifestations,24-hour urinary protein quantity and renal pathological grades of the 2 groups were collected and analyzed.Results In 167 HSPN children,the ratio of male to female was 1.8：1.0.The ages from 5 to 10 years old accounted for 70.7％.Renal injurytime was from a day to 5 months,91.6％ of the HSPN children occurred renal damage within 1 month.HSPN children had clinical signs of gastrointestinal involvement in 56 cases（33.5％）,at the same time,the digestive tract and joint involvement in 52 cases（31.1％）.Pathological classification of 6 grades：8 cases（4.8％） of grade Ⅰ ;32 cases（19.2％） of grade Ⅱ ;124 cases （74.3 ％） of grade Ⅲ ;3 cases （1.8％） of grade Ⅳ ; no grade Ⅴ or Ⅵ.Pathologic grade of group B was higher than group A,and the difference was significant （P ＜ 0.05）.Conclusions The HSPN children,expecially the boys,were more found with digestive tract injury or multiple organ damage.Most HSPN children occurred renal damage within 1 month.The renal biopsy of HSPN children should be positive,especially when the 24-hour urinary protein quantity is ≥25 mg/kg.

关 键 词：紫癜性肾炎 肾活检 病理 尿蛋白 儿童 

分 类 号：R726.9[医药卫生—儿科]