【摘要】 目的总结我院儿科22年来儿童原发性IgA肾病的发病率、发病诱因、临床分型和病理分级情况及临床分型与病理分级间的关系。方法回顾性分析256例原发性IgA肾病患儿的临床分级、病理分级、实验室检查及临床分型与病理分级间的关系。结果儿童IgA肾病占同期肾活检患儿的14·2%;IgA肾病的诱发因素依次为呼吸道感染126例(占49·2%),胃肠道感染43例(占16·8%)、慢性扁桃体炎24例(占9·4%)和劳累12例(占4·7%);临床分型中孤立性血尿型134例(占52·3%),肾病综合征型63例(24·6%),血尿和蛋白尿型39例(15·2%);病理改变以Ⅲ级为主(147例,57·4%),免疫沉积物荧光检查系膜区均有IgA沉积(100%),免疫病理分型以IgA+IgG型最多105例(占41%),IgA+IgG+IgM型77例(占30%)、单纯IgA型43例(占17%)、IgA+IgM型31例(占12%);肾脏病理损害的程度与免疫沉积物的种类有关,伴有IgM沉积者肾脏病理损害的程度较重。结论随着肾活检的广泛开展,IgA肾病的检出率逐步提高,IgA肾病临床表现的多样性及病理改变的程度、免疫沉积物的种类对指导治疗与判断预后具有重要的意义。更多还原

【Abstract】 Objective To analyze the incidence,inducement,clinical typing,pathological classification and relationship between clinical classification and pathology of 256 children with IgA nephrosis.Methods Clinical typing,pathological classification,laboratory examination and relationship between clinical typing and pathological classification of 256 children were analyzed retrospectively.Results Children with IgA nephrosis occupied 14.2% of all the patients received renal biopsy at the corresponding time.The inducement included respiratory infection 126(49.2%),gastrointestinal infection 43(16.8%),chronic tonsillitis 24(9.4%),tiredness 12(4.7%).The clinical typing included isolated hematuria 134(52.3%),nephrotic syndrome 63 (24.6%),hematuria and proteinuria 39(15.2%).147(57.4%) showed Ⅲ grade pathological change;all the cases showed IgA deposition in the mesangial region;the immune pathological classification showed IgA+IgG type 105(41%),IgA+IgG+IgM type 77(30%),simple IgA type 43(17%),IgA+IgM type 31(12%);the positive correlation could be found between types of deposited immune complex and pathological lesion extent,children with IgM type deposition had more serious pathological lesion.Conclusion The final diagnosis rate of IgA nephrosis elevated step by step with the widespread renal biopsy,the various clinical manifestation,pathological change extent and the type of depositional immune complex can be helpful to guide the treatment and judge the prognosis.更多还原