184例小儿紫癜性肾炎Ⅲ级病变的病理和中西医临床分型特点  

Pathologic and clinical classification of traditional Chinese and western medicine with 184 children with grade Ⅲ lesions of henoch schonlein purpura nephritis

作　　者：黄岩杰[1] 杨晓青[1] 张笑聪 李静[1] 李金刚[1] 翟文生[1] 任献青[1] 张建[1] 郭庆寅[1] 杨濛[1] 张霞[1] 丁樱[1] 

机构地区：[1]河南中医学院第一附属医院儿科,郑州450000 [2]河南中医学院,郑州450008

出　　处：《中华中医药杂志》2014年第10期3327-3329,共3页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：河南中医学院2011年博士科研基金(No.BSJJ2011-10);2012年河南省高校科技创新人才支持计划(No.2012HASTIT019)~~

摘　　要：目的:探讨小儿紫癜性肾炎(HSPN)Ⅲ级病变的病理和中西医临床分型的特点。方法:将184例HSPNⅢ级病变分组:1Ⅲa伴新月体<25%,99例;2Ⅲa伴25%≤新月体<50%,11例;3Ⅲb伴新月体<25%,42例;4Ⅲb伴25%≤新月体<50%,32例。结果:184例HSPNⅢ级病变中,血尿和蛋白尿型最常见,共139例,占75.54%。对血尿和蛋白尿型的24小时尿蛋白定量进行组间比较,Ⅲa型两组,Ⅲb型两组,Ⅲa、Ⅲb伴新月体<25%的两组,Ⅲa、Ⅲb伴25%≤新月体<50%的两组比较,均存在显著性差异(P<0.01)。中医临床分型的主证以血热妄行、气阴两虚型多见,标证以血瘀、湿热证常见。结论:不仅系膜增生的程度,新月体形成的百分比也是促使HSPNⅢ级病变患儿24小时尿蛋白定量升高和决定肾损伤轻重程度的重要病理因素。Objective： To investigate the pathologic and clinical classiffication of traditional Chinese and western medicine with 184 children with grade Ⅲ lesions of henoch schonlein purpura nephritis（HSPN）. Methods： 184 children with grade Ⅲ of HSPN were divided into 4 groups： 1Ⅲ a with crescent25%, 99 cases; 2Ⅲ a with 25%≤crescent50%, 11 cases; 3Ⅲ b with crescent25%, 42 cases; 4Ⅲ b with 25%≤crescent50%, 32 cases. Results： The predominant clinical manifestation of grade Ⅲ of HSPN in this study was hematuria and proteinuria, and there were 139 patients with hematuria and proteinuria in 184 cases（accounted for 75.54%）, followed by nephrotic syndrome. There were signifficant differences of 24 hours urinary protein quantity（24h-UPQ） in 139 patients with hematuria and proteinuria among Ⅲa group, Ⅲb group, group of Ⅲa and Ⅲb with crescent25%, group of Ⅲa and Ⅲb with 25%≤crescent50%（P〈0.01）. The principal syndromes of clinical classiffication of Chinese medicine were syndrome of stirring blood due to intense heat and syndrome of defficiency of both qffiand yin. The secondary syndromes were syndrome of blood stasis and syndrome of dampness-heat. Conclusion： Not only the degree of mesangial proliferation, but also the percentage of the crescent formation is an important pathological factor for increasing of 24h-UPQ and determine of kidney injury severity.

关 键 词：小儿紫癜性肾炎 Ⅲ级病理改变 新月体 系膜增生 临床分型 辨证分型 

分 类 号：R726.9[医药卫生—儿科]