95例儿童紫癜性肾炎的临床、病理和治疗体会  

Clinical,Pathological and Therapeutic Experience in the Treatment of 95 Cases of Henoch-Schonlein Purpura Nephritis

作　　者：杨玲云 赵丽萍[1] 吴晴[1] 周红霞[1] 葛婷婷[1] 张林[1] 姜新宇[2] YANG Lingyun;ZHAO Liping;WU Qing;ZHOU Hongxia;GE Tingting;ZHANG Lin;JIANG Xinyu(Department of Nephrology,b.Department of Radiology,Wuxi Children′s Hospital,Wuxi 214002,China;Department of Radiology,Wuxi Children′s Hospital,Wuxi 214002,China)

机构地区：[1]无锡市儿童医院肾内科,江苏无锡214002 [2]无锡市儿童医院影像科,江苏无锡214002

出　　处：《医学综述》2018年第8期1648-1651,1656,共5页Medical Recapitulate

基　　金：无锡市科技发展资金项目(CSE31N1412);无锡市医院管理中心面上项目(YGZXM1535);无锡市卫生局科研项目(MS201426)

摘　　要：目的探讨儿童紫癜性肾炎(HSPN)的临床表现、病理特点以及疾病的转归。方法统计分析2006年5月至2013年1月无锡市儿童医院收治的95例HSPN患儿的临床表现和病理改变,随访时间32~96个月。结果病理Ⅰ级26例(27.3%)、Ⅱa级23例(24.2%)、Ⅱb级3例(3.1%)、Ⅲa级35例(36.8%)、Ⅲb级8例(8.4%),未见Ⅳ级患儿。临床表现为孤立性血尿的肾脏病理Ⅰ级8例(72.7%),孤立性蛋白尿和血尿、蛋白尿中病理为Ⅱ、Ⅲ级43例(74.1%),急性肾炎型和肾病综合征型中病理为Ⅲ级18例(69.2%)。6例重复肾活检病例中有3例病理改变明显加重,调整治疗方案,其余患儿转归良好。随访中发现12例患儿经糖皮质激素后出现高眼压。结论儿童HSPN以血尿和蛋白尿型及肾病综合征型为主,病理分型以Ⅱ级及Ⅲ级为主,但血尿、蛋白尿和肾病综合征型病理改变加重。有蛋白尿表现的患儿应动员其及早进行肾组织活检,对表现为孤立性血尿的患儿应加强尿微量蛋白的监测。糖皮质激素所致高眼压应得到重视。Objective To investigate the clinical manifestation,pathological characteristics and prognostic of Henoch-Schonlein purpura nephrite(HSPN)in children.Methods Analysis on the clinical manifestation and pathological characteristics of 95 cases of HSPN in children was done.The follow-up time ranged from 32 months to 96 months.Results Patho logical classification of 6 grades:26 cases(27.3%)of gradeⅠ,23 cases(24.2%)of gradeⅡa,3 cases(3.1%)of gradeⅡb,35 cases(36.8%)of gradeⅢa,8 cases(8.4%)of gradeⅢb,no gradeⅣ.8 cases(72.7%)of pathological change in patients with simple hematuria were gradeⅠ.There were 43 cases(74.1%)gradeⅡand gradeⅢin simple proteinur and hematuria and proteinuria.18 cases(69.2%)of gradeⅢwere found in clinical types of nephrotic syndrome and acute nephritis.Six patients had second renal biopsy,three of which worsened and needed to adjust treatment,others in remission.We found intraocular pressure increased by glucocorticoid in 12 cases during the follow-up.Conclusion In children,the most common clinical types of HSPN are hematuria and proteinuria type and nephrotic syndrome type.The major of pathological changes in HSPN are gradeⅡand gradeⅢ.The clinical type of hematuria and proteinuria of nephrotic syndrome are of higher grade of pathological classification.Patients with proteinuria should have renal biopsy as early as possible.And we should strengthen the monitoring of urinary micro protein in patients with simple hematuria.We should pay attention to high intraocular pressure caused by glucocorticoid.

关 键 词：儿童 过敏性紫癜 肾炎 

分 类 号：R692.34[医药卫生—泌尿科学]