儿童紫癜性肾炎肾脏病理分级与临床特征关系探讨VIP专享VIP免费

儿童紫癜性肾炎肾脏病理分级与临床特征关系探讨任献国，张沛，高远赋，樊忠民，高春林，茅松，何旭，夏正坤，任献青，刘光陵·2441··论著·【摘要】目的探讨儿童紫癜性肾炎肾脏病理分级与年龄分期、免疫荧光分型及临床分型的关系。方法选取2008—01—01—2012一O1—01南京军区南京总医院儿科肾穿刺活检病理检查诊断为紫癜性肾炎患儿120例，根据病理检查分为I级、Ⅱ级、Ⅲ级、Ⅳ级；根据年龄分为婴幼儿期、学龄前期、学龄期、青春期；根据免疫荧光分为单纯IgA沉积型、IgA+IgG沉积型、IgA+IgM沉积型、IgA+IgG+IgM沉积型；根据临床分型分为孤立性血尿型、孤立性蛋白尿型、血尿和蛋白尿型、肾病综合征型、慢性肾炎型。分析其病理分级与年龄分期、免疫荧光分型、临床分型的关系。结果120例患儿均存在皮肤紫癜症状，以双下肢对称性出血性皮疹最多见；伴胃肠道症状82例(68．3％)，关节痛62例(51．7％)。均以肾小球弥漫颗粒状IgA伴C3沉积为特点。I级3例(2．5％)，Ⅱ级51例(42．5％)，Ⅲ级62例(51．7％)，1V级4例(3．3％)。不同’g-组织病理分级患儿年龄分期间差异无统计学意义(：7．497，P=0．586)；不同肾组织病理分级患儿免疫荧光分型间差异有统计学意义(X2=25．930，P=0．002)；不同肾组织病理分级患儿临床分型间差异有统计学意义(X2=29．557，P=O．003)。结论临床表现严重的紫癜性肾炎患儿肾脏病理分级较重，免疫球蛋白沉积类型较多。【关键词】紫癜性肾炎；病理；临床分型；儿童【中图分类号】R726．923．4【文献标识码】Adoi：10．3969／j．issn．1007—9572．2013．07．077任献国，张沛，高远赋，等．儿童紫癜性肾炎肾脏病理分级与临床特征关系探讨[J]．中国全科医学，2013，16(7)：2441—243．[www．chinagp．net]RelationshipbetweenRenalPathologyandCHnicaiCharacteristicinChildhoodHenoch—SchiinleinPurpuraNeph~fisRENXian—guo，ZHANGPei，GAOYuan一丘，eta1．DepartmentofPediatrics，NanjingGeneralHospitalofNanjingMilitaryCommand，Nanjing210003，China【Abstract】0bjectiveToanalyzetherelationshipbetweenrenalpathology，agestages，renalimmunofluorescencetypesandclinicalclassificationinchildhoodHenoch—Schonleinpurpuranephritis(HSPN)．Methods120childrendiagnosedbyrenalbiopsyasHSPNfromJanuary2008toJanuary2012inNanjingcommandofJinglinghospitalwerereviewed．AccordingtopathologicaltypesthepatientsweredividedintoclassI，classI1，classⅢandclassIV．Accordingtoagestages，thepatientsweredividedintoinfant，preschool，schoolage，adolescence．Accordingtoimmunofluoresceneedeposition，thepatientsweredividedintoIgAtype，IgA+IgGtype，IgA+IgMtypeandIgA+IgG+IgMtype．Accordingtoclinicalclassification，thepa—tientsweredividedintoisolatedhematuria，isolatedproteinuria，hematuriaandproteinuria，nephrotiesyndromeandchronicne—tis．Therelationshipbetweenpathologicalgrade，agestages，immunofluorescenceclassificationandclinicaltypelyzed．ResultsAllthe120patientshadskinpurpuraandthehemorrhagicrashofthelowerlimbswasthemostcommonseen82caseswereaccompaniedwithgastrointestinalsymptoms(68．3％)and62caseswereaccompaniedwitharthralgia(51．7％)．ThedepositiononglomeruluswithIgAandC3werecharacterizedoneverycase．3CaSeSweregradeI(2．5％)，51casesweregradelI(42．5％)，62casesweregradeⅢ(51．7％)and4casesweregradeIV(3．3％)．Thediferenceofhistologicalgradeandagestagewasnotstatisticallysignificant(X2：7．497，P=0．586)，butthediferenceofhistologicalgradeandimmunofluores·cencetypeswasstatisticallysignificant(=25．930，P=0．002)．Thedifferenceofhistologicalgradeandclinicalclassificationwasalsostatisticallysignificant=29．557，P=0．003)．ConclusionThemoresevereofclinicalmanifestationinpurpuranephritischildren，themoresevereoftheirrenalpathologyan...