儿童狼疮性肾炎35例临床病理分析

Clinical and pathological analysis on 35 children lupus nephritis

目的:探讨儿童狼疮性肾炎(LN)的临床特点及其与肾脏病理类型之间的关系. 方法:回顾性分析35例LN患儿(其中30例有完整肾病理检查资料)的临床表现、实验室和病理检查资料. 结果:35例LN患儿中,男11例,女24例,男∶女=1∶2.2, 平均发病年龄为10.1岁,发病高峰为10～14岁女性患儿(占42.9%).35例患儿以肾症状为首发临床表现者占42.8%,最常见的临床症候为肾病综合征(65.7%);肾外症状以发热(60%)、皮肤损害(57.1%)、关节炎(40%)等多见; 实验室检查以贫血(45.7%)、补体C3下降(77.1%)、抗核抗体(ANA)阳性(85.7%)、抗ds-DNA阳性(51.4%)常见. 30例肾活检均异常,病理类型以Ⅳ型LN最多,占70%, 其次是Ⅱ型占16.7%.其中3例重复肾活检,Ⅳ型转Ⅲ型2例,V型转Ⅳ型1例. 结论: 儿童期LN的临床表现及病理检查有其自身特点.

Objective： To explore the clinical features of lupus nephritis （LN） in childhood and their relationship with renal pathological types. Methods ： The clinical and laboratory data of 35 cases of lupus nephritis （LN） in childhood （of which ,30 have integrated renal pathological data） were retrospectively analyzed. Results ： Of the 35 cases of LN, there were 11 males and 24 females, with a ratio of male to female 1 ： 2.2, and the mean age of 10.1 years. The incidence rate of female patients between 10 and 14 years was the highest, with a percentage of 42.9%. All patients showed renal lesion, and some of those punctured patients had kidney disease as their initial manifestations （42.8%）. In these patients, the incidence rate of nephrotic syndrome was 65.7% and fever 60% , skin lesion 57.1% , arthritis 40%. Laboratory examination, anemia 45.7%, decreased C3 complement 77.1%, ANA 85.7% ,anti-dsDNA 51.4%. All the 30 punctured cases showed some abnormality of renal pathology. Class Ⅳ had the largest cases with a percentage of 70% , followed by class Ⅱ （ 16.7% ）. Of all cases, 3 cases were repeated renal biopsy, 1 case of class Ⅳ turn to class Ⅲ, 2 case of class Ⅴ turn to class Ⅳ. Conclusion：The clinical features of lupus nephritis in childhood and their relationship with renal pathological types showed their own characteristics, but the pathological class showed little correlation with clinical features. To emphasize the value of renal biopsy of LN in childhood is of great importance.