儿童狼疮肾炎56例临床分析  

Lupus nephritis in children:clinical analysis of 56 cases

作　　者：何艳燕[1] 刘艳云[2] 魏珉[1] 

机构地区：[1]中国协和医科大学北京协和医院儿科,100730 [2]黑龙江双鸭山矿务局总医院儿科

出　　处：《中国实用儿科杂志》2003年第12期730-732,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　回顾分析狼疮肾炎患儿的临床资料及长期生存状况 ,探讨儿童狼疮肾炎 (LN)的临床特点、分析影响其预后和长期生存率的相关因素。方法　收集自 1990～ 2 0 0 1年住院治疗、符合美国风湿病学会 (1982年 )关于系统性红斑狼疮 (SLE)及其肾损害诊断标准、年龄小于 18岁的患儿资料 ,对其进行回顾性分析。结果　 92例SLE儿童中 ,合并LN者 5 6例 ,发生率为 6 0 9% ;年龄 4 8～ 15 9岁 ,平均年龄 (12 8± 2 3)岁 ;男女比例 3∶1。5 6例LN中临床以水肿或尿异常起病者 11例 (19 6 % ) ,以发热、皮疹等全身症状起病者 4 5例 (80 4 % ) ;发生LN的高危因素为血浆抗双链DNA(dsDNA)抗体升高和低补体。有完整随访资料的 4 8例 ,平均随访 (4 92± 2 6 3)年 ,其 1年、5年和 >10年的肾脏生存率分别为 94 8%、89 5 %、81 9% ;男性、贫血、SLE疾病活动指数≥ 2 0、肾脏病理评分活动性指数≥ 7、慢性指数≥ 4和病理分型Ⅳ型是影响LN预后的重要因素。结论　在儿童SLE中 ,LN发生率高 ;其发生的高危因素是血浆dsDNA抗体升高和补体降低。积极合理个体化的治疗可明显改善预后。感染仍然是儿童LN死亡的主要原因。Objective To investigate the characteristics and prognosis of LN(lupus nephritis) in childhood,and to analyze the related factors to long-term survival and prognosis.Methods A retrospective study of 56 children with renal involvement among 92 children with SLE from 1990 to 2001 was conducted.Results The prevalence of LN was 60.9%.The mean age was 12.8±2.3 year (range 4.8～15.9 years).The female to male ratio was 3∶1.Eleven of 56 children (19.6%) had renal symptoms at the onset of the disease.Anti-dsDNA and hypocomplementemia were high risk factors in the development of LN.The mean follow-up was (4.9±2.6) year,the actual renal survival rate was 94.8% in the first year,89.5% at 5 year,and 81.9% at over 10 year.Male,anaemia,SLEDAI≥20 scores,histologic chronicity index≥4 and class Ⅳwere the prognostic factors of LN.Conclusion The prevalence of LN is high in children.Anti-dsDNA and hypocomplementemia are high risk factors in the development of LN.Infection is the leading cause for death in LN.

关 键 词：儿童 狼疮肾炎 相关因素 预后 长期生存率 临床分析 肾损害 

分 类 号：R725.932.4[医药卫生—儿科]