377例儿童肾活检病理及临床分析

Analysis of pathological and clinical manifestations in 377 children with renal disease

目的:探讨儿童肾小球疾病病理特点及其与临床表现的关系。方法:回顾性分析1999年2月～2006年2月在重庆医科大学附属儿童医院进行肾活检的377例患儿病理及临床资料,比较原发性肾小球疾病和继发性肾小球疾病的病理和临床特征。结果:(1)377例肾活检患儿中,原发性肾小球疾病217例,继发性肾小球疾病158例,遗传性肾小球疾病和肾血管疾病各1例。(2)原发性肾小球疾病组最常见的临床表现和病理类型分别为肾病综合征和系膜增生性肾小球肾炎(Mesangial proliferative glomerulonephritis,MsPGN),继发性肾小球疾病组中分别为过敏性紫癜性肾炎和MsPGN。与原发性肾小球疾病组比较,继发性肾小球疾病组平均发病年龄、肾组织内IgA沉积的发生率均较高(分别P<0.05、P<0.01),除第一病理诊断外,局灶节段性肾小球硬化症(Focal segmental glomerulosclerosis,FSGS)和(或)肾小管病变的发生率较高(P<0.01)。结论:(1)原发性肾小球疾病仍为儿童常见的肾小球疾病,随着年龄的增长,继发性肾小球疾病逐渐增多。本组儿童肾小球疾病的病理类型以MsPGN最为常见。(2)继发性肾小球疾病的病理组织中,以IgA的沉积最常见,提示IgA的局部沉积是导致FSGS和(或)肾小管病变的重要因素。

Objective：To explore the relationship between the pathological classification and clinical manifestations of renal glomerular disease in children, Methods：Pathological diagnosis and laboratory routine examinations of total 377 patients with renal disease during Feb,1999 to Feb,2006 were reviewed and compared. Results：（1）There were 250 male and 127 female among 377 patients who received renal biopsy,and the ratio of male to female was 1,97, Among these patients,217（57,6%） cases of primary glomerular disease, 158（41,9%） cases of secondary glomerular disease, 1（0,25%） case of heritage glomerular diseases and 1 case of renal vascular disease were found, respectively, （2）The most common clinical diagnosis and pathological category in primary glomerulary disease were nephritic syndrome and mesangial proliferative glomerulonephritis （MsPGN）, respectively,and that in secondary glomerulary disease were Henoch-Schonlein purpura nephritis and MsPGN,respectively. The mean age in group of secondary glomerulary disease [（10.36±2.83）years] was older than that in group of primary glomerulary disease[（9.72 ± 3.07）years],（P〈0.05）. The incidence of IgA deposition within renal tissue and the incidence of focal segmental glomerulosclerosis（FSGS） and or tubulopathy other than the first pathological diagnosis in secondary glomerulary disease（84.2%, 36,1%, respectively） were higher than those in primary glomerulary disease（54.4%, 22.6%,respectively）, （p〈0.01, respectively）. Conclusions： （1）Primary glomerulary disease is still common glomerulary disease in children,and secondary glomerulary disease develops gradually with the increasement of age. MsPGN is the most common pathological category in children glomerulary disease. （2）In secondary glomerulary disease,the higher incidence of FSGS and or tubulopathy are possibly due to the higher incidence of IgA deposition within renal tissue.