凉山彝族地区儿童紫癜性肾炎临床病理特点及预后分析  

Clinicopathological features and prognosis of Henoch-Schonlein purpura nephritis in children of the Liangshan Yi region

作　　者：李群[1] 石艳[1] 花媛媛 黄兴琼 周继敏[1] 张月 LI Qun;SHI Yan;HUA Yuanyuan;HUANG Xingqiong;ZHOU Jimin;ZHANG Yue(Department of Paediatrics,The First People's Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,Sichuan,China)

机构地区：[1]凉山彝族自治州第一人民医院儿科,四川西昌615000

出　　处：《西部医学》2024年第6期895-898,905,共5页Medical Journal of West China

基　　金：凉山州州级科研项目(20ZDYF0136)

摘　　要：目的探讨凉山彝族地区儿童紫癜性肾的临床病理特点及预后。方法收集2014年1月—2019年12月我院诊断为紫癜性肾炎的患儿383例的临床资料,完善肾组织活检的患儿52例,将临床、病理资料进行回顾性分析,总结凉山彝族地区儿童紫癜性肾炎的年龄、性别、民族分布情况、临床病理特点及预后。结果383例紫癜性肾炎患儿中彝族发病高于汉族(彝∶汉=1.87∶1),彝族女性儿童发病高于彝族男性儿童(彝族女∶彝族男=1.25∶1),汉族女性儿童发病低于汉族男性儿童(汉族女∶汉族男=0.87∶1)。从发病到尿检异常时间看,70.3%肾损害发生在1月内,临床分型主要以血尿和蛋白尿型为主,等级间差异有统计学意义(Z=1.982,P=0.042),其次是肾病综合征型,病理分级以Ⅱ、Ⅲ级为主,占88.4%,在病理分级Ⅱ、Ⅲa级中也以血尿和蛋白尿型为主,病理Ⅲb级以上以肾病综合征型为主,临床分型与病理分级关系各组之间比较差异有统计学意义(均P<0.05),但尤以肾病综合征型差异有显著意义(Z=2.626,P<0.001);尿蛋白定量越高(P<0.05),病理分级越高。汉族和彝族在不同病理分级的比较差异有统计学意义(Z=2.044,P=0.041),彝族儿童肾脏损害程度显得更重;而不同性别在病理分级的比较差异无统计学意义(P≥0.05)。激素、免疫抑制剂、ACEI等治疗效果良好。结论凉山地区儿童紫癜性肾炎以彝族女性儿童发病率更高。同时病理分级与尿蛋白定量呈正相关,且病理分级越高,临床分型以肾病型为主,但也存在病理分级与尿蛋白定量、临床分型不一致表现,提示早期肾活检的重要性;激素和免疫抑制剂治疗效果肯定,预后大多良好。Objective To explore the clinicopathological features and prognosis of Henoch-Schonlein purpura nephritis in Yi children.Methods The clinical data of 383 cases of children with purpura nephritis diagnosed in our hospital were collected from January 2014 to December 2019,and 52 cases of children with perfect renal tissue biopsy were collected,and clinical and pathological data were retrospectively analyzed to summarize the age,gender,ethnic distribution,clinicopathological characteristics and prognosis of children with purpura nephritis in the Yi ethnic region of Liangshan.Results Among the 383 children with purpura nephritis,the incidence of Yi was higher than that of Han(Yi∶Han=1.87∶1),the incidence of female children of Yi was higher than that of male children of Yi(Yi female∶Yi male=1.25∶1),and the incidence of female children of Han was lower than that of male children of Han(Han female:Han male=0.87∶1).70.3%of the renal damages occurred within one month,and the clinical typology was dominated by haematuria and proteinuria,followed by nephrotic syndrome,and the clinical pathology was dominated by haematuria and proteinuria.The clinical typing was dominated by hematuria and proteinuria type,followed by nephrotic syndrome type,and the pathological grading was dominated by gradeⅡandⅢ,which accounted for 88.4%of the cases.Hematuria and proteinuria type was dominated in pathological gradeⅡandⅢa,and nephrotic syndrome type was dominated in pathological gradeⅢb or above,and the difference between the clinical typing and the relationship between pathological grading between the various groups was statistically significant,but the difference in the nephrotic syndrome type in particular was significant(z=2.626,P<0.001).The higher the quantitative urine protein,the higher the pathological grading.The difference between Han and Yi in the comparison of different pathological grading was statistically significant(z=2.044,P=0.041),and the degree of renal damage appeared to be more severe in Yi children;w

关 键 词：彝族儿童 紫癜性肾炎 病理特点 预后 

分 类 号：R692.34[医药卫生—泌尿科学]