儿童紫癜性肾炎预后的相关因素分析  

Prognosis factors of Henoch - Schonlein purpura nephritis in children

作　　者：冯丹[1] 郝胜[1] 钮小玲[1] 王平[1] 吴滢[1] 张薇[1] 朱光华[1] 何威逊[1] 黄文彦[1] 

机构地区：[1]上海交通大学附属儿童医院上海市儿童医院肾脏风湿科,200062

出　　处：《中华实用儿科临床杂志》2016年第9期679-682,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市教委重点创新项目（13ZZ013）

摘　　要：目的探讨影响紫癜性肾炎（HSPN）患儿预后的相关因素。方法回顾性分析2009年1月至2013年12月在上海市儿童医院（上海交通大学附属儿童医院）肾脏科住院并有完整肾穿刺活检病理资料的确诊为HSPN的137例患儿临床资料，对其性别、年龄、临床特征、病理变化与预后间的关系进行统计学分析。结果（1）137例HSPN患儿经过（43．10±16．39）个月随访，99例（72．26％）患儿尿检恢复正常（A级），36例（26．28％）患儿轻微尿异常（B级），仅2例仍为活动性。肾病（C级），无一例进展为肾功能不全（D级）。（2）24h尿蛋白定量、血尿素氮（BUN）、血肌酐（Scr）、血胱抑素（Cys—C）、IgA及凝血酶时间（TT）越高，肾小球滤过率（GFR）越低，预后越差。（3）HSPN患儿临床表现以血尿和蛋白尿多见（111／137例，81．02％），其中80例（72．07％）预后为A级，仅1例（0．90％）表现为c级。临床以急进性肾炎起病的1例患儿预后差，为c级。HSPN预后与临床表现密切相关，差异有统计学意义（P〈0．001）。（4）HSPN患儿病理分级Ⅲ级及以上者预后A级41例（63．08％），B级22例（33．84％），C级2例（3．08％）。病理损伤程度与预后明显相关，病理损伤程度越重，预后越差（P〈0．05）。HSPN患儿肾小管一问质损伤以＋级为主（66．4％），其中69例（75．82％）预后为A级，21例（23．08％）为B级，1例（1．09％）为C级，间质损伤与预后无明显相关性（P〉0．05）。结论HSPN预后与临床表现、病理损伤程度明显相关，24h尿蛋白定量、BUN、Cr、Cys—C、IgA及，丌越高，则GFR越低、预后越差。但HSPN经过及时、积极规范的治疗，预后仍然乐观。Objective To investigate the outcome predictors of renal injury in children with Henoch - Schon- lein purpura nephritis（HSPN）. Methods One hundred and thirty - seven patients with HSPN, who were admitted to Shanghai Children＇s Hospital from January 2009 to December 2013 ,were retrospectively studied. The data of gender, age, clinical features, and pathological changes were collected. Results （ 1 ） Among the 137 children,whose median duration of follow - up was （43.10 ± 16.39） months, 99 cases （72.26%） had good outcomes（ grade A） , 36 cases （26.28%） had grade B, only 2 cases without remission （grade C ）, and no cases progressed to renal failure （grade D）. （2） Patients had relatively poor prognosis if they were presented with the higher urine protein, blood urea nitrogen （ BUN）, serum creatinine （ Cr）, cystatin C （ Cys - C ）, IgA, thrombin time （ TT）, and the lower glomerular filtration rate （GFR）. （3）The most common clinical types of HSPN were hematuria and proteinuria （111/137 cases ,81.02% ） , and 80 cases of them （72.07%） achieved grade A, and only 1 case （0.90%）got grade C. Only 1 case whose clinical ma- nifestations was acute nephritis got grade C. Clinical manifestations were associated with prognosis of HSPN （ P 〈 0.001 ）. （4）The prognosis of children belonged to grade A in 41 cases（63.08% ）, whose pathological findings were grade m and above, 22 cases （33.84%） belonging to grade B, and grade C in 2 cases （3.08%）. The prognosis of HSPN was associated with pathological stage（ P 〈 0.05 ）. Patients with renal tubular - interstitial damage indicating with ＋ accounting for 66.4%. Among them 69 cases（75.82% ） had grade A, 21 cases（23.08% ） had grade B, and 1 case （ 1.09% ） had grade C. No obvious correlation was found in interstitial injury and prognosis （ P 〉 0.05 ）. Conclusions The prognosis of HSPN is associated with clinical classification, pathological stage. Moreover,the prog- nosis pre

关 键 词：紫癜性肾炎 临床表现 病理损伤程度 预后 回顾性调查 

分 类 号：R726.9[医药卫生—儿科]