【摘要】 目的探讨儿童紫癜性肾炎(Henoch-Schnlein purpura nephritis,HSPN)的临床和病理特点及其相关性,以指导治疗,改善预后。方法收集2000年1月至2008年10月收治的55例紫癜性肾炎患儿的临床及病理资料,并且根据不同的条件分组进行回顾性分析。结果临床分型中以血尿和蛋白尿最多,为22例(40.0%);肾病综合征型次之,16例(29.1%);单纯性蛋白尿或单纯性血尿型、急性肾炎型和急进性肾炎型占少数,分别为6例(10.9%)、4例(7.3%)和1例(1.8%)。伴有消化道症状的紫癜性肾炎患儿,临床上较无消化道症状的患儿易有肾病水平蛋白尿(P<0.05)。伴肉眼血尿患儿比镜下血尿者易出现肾病综合征(P<0.05)。根据ISKDC标准,HSPN病理分级以Ⅱ级和Ⅲ级最多,分别为27例(49.1%)和16例(29.1%)。免疫荧光检查显示IgA+IgG+IgM型为32例(58.2%),伴C3沉积41例(74.6%),病理分级主要在Ⅲ级以上。免疫沉积类型、C3沉积与病理分级有相关性(P<0.05)。临床表现为单纯性血尿型或单纯性蛋白尿型的HSPN病理损害较轻,7例(58.3%)为Ⅱ级;血尿和蛋白尿型的病理分级以Ⅱ级和Ⅲ级多见,分别为12例(54.5%)和5例(22.7%);肾病综合征型的病理分级多见Ⅲ级以上,为10例(62.5%)。结论儿童紫癜性肾炎临床以血尿和蛋白尿型及肾病综合征型为主,病理分级以Ⅱ级和Ⅲ级最常见,免疫沉积物类型与C3沉积和病理分级有相关性。HSPN临床症状和病理损伤程度基本一致;消化道受累程度越重,出现蛋白尿的比例越高;肉眼血尿与肾脏损害的严重程度有关。更多还原

【Abstract】 Objective To explore clinical,pathological features of Henoch-Schnlein purpura nephritis(HSPN) and their relationship in children.To provide references for the treatment and improve the life quality of the patients.Methods A total of 55 patients with HSPN were admitted to hospital from January 2000 to October 2008.The clinical and pathological data were retrospectively collected,grouped according to different conditions and analyzed.Results Hematuria and proteinuria was the most common clinical type with 22 cases(40.0%),followed by nephrotic syndrome with 16 cases(29.1%),while simple hematuria or proteinuria,acute glome rulonephritis and rapidly progressive glomerulone phritis were 6 cases(10.9%),4 cases(7.3%) and 1 case(1.8%) respectively.The percentage of nephrotic level porteinuia in cases with gastrointestinal symptoms was higher than that in cases without gastrointestinal symptoms(P < 0.05).The percentage of nephrotic syndrome in cases with gross hemaururia was higher than that in cases with microscopic hemaururia(P < 0.05).According to the standard of ISKDC,the majority of pathological changes of HSPN were grade Ⅱ with 27 cases(49.1%) and grade Ⅲ with 17 cases(29.1%).The percentage of deposition of IgA + IgG + IgM was 32 cases(58.2%) while 41 cases(74.6%) had C3 deposition;their pathological changes were mainly above Grade Ⅲ.Immune complex deposition and C3 deposition were associated with pathologic classification(P < 0.05).Simple hematuria or peoteinuria had mild pathological changes with 7 cases(58.3%) of Grade Ⅱ.The pathological changes of hematuria and proteinuria type were mainly Grade II and Ⅲ with 12 cases(54.5%) and Grade Ⅲ with 5 cases(22.7%).The majority of the pathological changes of nephrotic syndrome type were above Grade Ⅲ with 6 cases(37.5%).Conclusions The HSPN patients mainly show the type of hematuria and proteinuria and the type of nephrotic syndrome.The majority of pathological changes of HSPN are grade Ⅱ and Ⅲ.Immune complex deposition and C3 deposition are associated with pathologic classification.In children with HSPN,clinical manifestation was consistent with pathological classification.Proteinuria is tending to become more severe when the gastrointestinal symptoms were prevalent and the extent of damage is severe.Gross hematuria has close relationship with the extent of renal injury.更多还原