儿童无症状性血尿的病理特征及肾活检指征的探讨  

Pathological characteristics of asymptomatic hematuria and indications of renal biopsy in children

作　　者：谢丹凤 阳海平[2] XIE Dan-feng;YANG Hai-ping(Department of Pediatric Internal Medicine,Sichuan Provincial Hospital for Women and Children,Chengdu 610000,China)

机构地区：[1]四川省妇女儿童医院儿内科,成都610000 [2]重庆医科大学附属儿童医院肾脏内科,重庆400014

出　　处：《中国临床新医学》2020年第5期487-491,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：四川省卫健委科研课题(编号:19PJ256)。

摘　　要：目的分析儿童无症状性血尿的病理特征,并探讨无症状性血尿患儿的肾活检指征。方法回顾性分析2010-01~2019-01在该院进行肾活检的204例无症状性血尿患儿的病理及临床资料,并根据血尿程度、合并蛋白尿程度及年龄进行分组,比较不同组间的一般临床特征、免疫球蛋白水平及病理类型。结果男性人数比例、年龄、病程、Ig A水平、Ig A肾病(IgAN)、肾小球轻微病变(GML)人数比例及未见肾小球人数比例在单纯性血尿组、血尿伴微量蛋白尿组和血尿伴中量蛋白尿组间比较差异有统计学意义(P<0.05)。肉眼血尿组患左肾静脉压迫综合征的人数比例高于镜下血尿组,差异有统计学意义(P<0.05)。24 h尿蛋白定量水平、GML人数比例在不同年龄组间比较差异有统计学意义(P<0.05)。结论不建议将单纯性血尿作为儿童早期肾活检的指征,但对于有肾脏病家族史或伴蛋白尿的无症状血尿患儿可适时行肾活检以早期明确诊断。Objective To analyze the pathological characteristics of asymptomatic hematuria in children,and to explore the indications of renal biopsy in children with asymptomatic hematuria.Methods The pathological and clinical data of 204 children with asymptomatic hematuria who underwent renal biopsy in our hospital from January 2010 to January 2019 were retrospectively analyzed,and the patients were divided into different groups according to the degree of hematuria,complications of proteinuria and age.The general clinical features,immunoglobulin levels and pathological types were compared among groups.Results The proportion of males,age,duration of disease,immunoglobulin A(IgA)level,IgA nephropathy(IgAN),proportion of glomerular minor lesion(GML),and proportion of the patients without glomeruli were statistically different among the simple hematuria group,the hematuria accompanied with microproteinuria group,and the hematuria accompanied with medium proteinuria group(P<0.05).The proportion of left renal vein compression syndrome in the gross hematuria group was significantly higher than that in the microscopic hematuria group(P<0.05).The quantitative levels of 24-hour urine protein and the proportion of GML were significantly different among the different age groups(P<0.05).Conclusion Simple hematuria is not recommended as an indicator of early renal biopsy in children,but renal biopsy can be performed in time for asymptomatic hematuria children with a family history of renal disease or proteinuria to make early diagnosis.

关 键 词：儿童 血尿 临床 病理 

分 类 号：R725[医药卫生—儿科]