紫癜性肾炎伴高血压患儿临床病理特征及预后分析  

Analysis of clinical pathological features and prognoses of children with Henoch-Sch nlein purpura nephritis with hypertension

作　　者：应蓓[1] 李宇红[1] 邵晓珊[1] 徐海霞[1] 邱杰[1] 郑莎莎[1] 张晓婵 刘远辉[1] 唐勇 黄艳[1] Ying Bei;Li Yu-hong;Shao Xiao-shan;Xu Hai-xia;Qiu Jie;Zheng Sha-sha;Zhang Xiao-chan;Liu Yuan-hui;Tang Yong;Huang Yan(Department of Nephrology of Immunization,Municipal Maternity&Child Care Hospital,Guiyang 550003,China)

机构地区：[1]贵阳市妇幼保健院肾脏免疫科,550003

出　　处：《临床肾脏病杂志》2021年第2期106-110,共5页Journal Of Clinical Nephrology

基　　金：2019年贵州省卫生健康委科学技术基金项目(gzwjkj2019-1-006);贵州省科技计划课题(黔科合LH【2015】7030号)。

摘　　要：目的分析过敏性紫癜性肾炎(henoch-Schonlein purpura nephritis,HSPN)伴高血压患儿临床和病理特征及预后特点。方法对2015年1月至2019年12月贵阳市妇幼保健院住院诊断为HSPN的148例患儿的临床及病理资料进行回顾性分析,根据患儿是否合并高血压分为HSPN血压正常组和HSPN伴高血压组,分析比较两组患儿临床病理特征及预后的差异。结果(1)148例HSPN患儿中血压正常105例(70.9%),伴高血压43例(29.1%),两组患儿在性别、年龄、起病时间上差异无统计学意义。(2)高血压组患儿夜间高血压发生率明显大于日间高血压发生率(χ^(2)=9.446,P<0.05)。两组患儿异常血压类型(非杓型及反杓型血压)发生率分别为79.1%、77.1%,差异无统计学意义。(3)高血压组24 h尿蛋白定量、尿微量白蛋白、血肌酐、血总胆固醇程度较血压正常组严重,差异有统计学意义(P<0.05),而血补体C3、血白蛋白、血小板计数差异无统计学意义。(4)高血压组临床分型以肾病综合征型为主,较血压正常组重,差异有统计学意义(χ^(2)=35.470,P<0.01)。高血压组病理分型均为Ⅲ型及Ⅲ型以上,较血压正常组重,差异有统计学意义(χ^(2)=25.642,P<0.01)。(5)与血压正常组比较,高血压组预后较差,差异有统计学意义(χ^(2)=6.663,P<0.05)。结论HSPN伴高血压患儿以夜间血压升高为主,其临床分型和病理分型较HSPN血压正常患儿严重,肾脏预后较差,应重视HSPN伴高血压患儿血压管理,改善患儿预后。Objective To explore the clinicopathological features and prognoses of children with Henoch-Sch nlein purpura nephritis(HSPN)with hypertension.Methods From January 2015 to December 2019,clinicopathological data of 148 HSPN children were retrospectively analyzed.According to whether or not there was a complication of hypertension,they were divided into the groups of HSPN with normal blood pressure(n=105,70.9%)and HSPN with hypertension(n=43,29.1%).The clinicopathological features and prognoses of two groups were compared.Results No significant inter-group difference existed in gender,age or onset time.The incidence of nocturnal hypertension was significantly higher than that of daytime hypertension in hypertension group(χ^(2)=9.446,P<0.01).And the incidence of abnormal blood pressure(non-dipper BP&reversed dipper BP patterns)was 79.1%and 77.1%in two groups respectively and the difference was statistically insignificant.Compared with normal blood pressure group,24-hour urinary protein quantity,degree of urinary microalbumin,serum creatinine and total cholesterol in hypertension group were more severe than those in normal blood pressure group and the difference was statistically significant(P<0.05).However,no significant difference existed in blood complement C3,serum albumin or platelet count.Nephrotic syndrome was a predominant clinical type in hypertension group and it was more severe than that in normal blood pressure group.And the difference was statistically significant(χ^(2)=35.470,P<0.01).The pathological classification of hypertension group was typeⅢand above and it was more severe than that of normal blood pressure group.And the difference was statistically significant(χ^(2)=25.642,P<0.01).As compared with normal blood pressure group,the prognosis of hypertension group was worse and the difference was statistically significant(χ^(2)=6.663,P<0.05).Conclusions HSPN children with hypertension is mostly characterized by elevated blood pressure at nighttime.The clinicopathological types are more severe th

关 键 词：过敏性紫癜性肾炎 高血压 儿童 肾脏病理 

分 类 号：R725.4[医药卫生—儿科] R726.9[医药卫生—临床医学]