紫癜性肾炎的早期诊断

Early Diagnosis of Henoch-Schonlein Purpura Nephritis

目的通过对尿分析及24h尿蛋白定量均正常的过敏性紫癜性肾炎(HSPN)患儿61例查尿微量蛋白及行肾活检并行病理分析,探讨早期肾活检的重要性。方法选择初治或复治,伴或不伴有关节及消化道症状,且尿分析及24h尿蛋白定量均正常的HSPN患儿,多次查尿微量蛋白,如尿微量蛋白正常或初检异常但1～2周内尿微量蛋白很快恢复正常者,不予肾活检,而持续尿微量蛋白异常或反复尿微量蛋白异常≥3次者行肾活检,观察病理变化;比较尿Alb的量、尿微量蛋白选择性与病理损害程度的关系,以及肾组织中免疫复合物IgA、IgG、IgM的沉积与病理损害程度之间的关系。采用SPSS11.0软件进行统计处理。结果所有尿分析及24h尿蛋白定量均正常,而持续尿微量蛋白异常或反复尿微量蛋白异常≥3次者,行肾活检,肾脏均有不同程度(Ⅱ～Ⅲ级)损害,其中Ⅱa26例(42.6%),Ⅱb10例(16.4%),Ⅲa21例(34.4%),Ⅲb4例(6.6%);且尿Alb的量、尿微量蛋白选择性与病理损害程度无明显相关性(Pa>0.05);随病理程度加重,肾组织中IgA+IgG+IgM共同沉积的比例增加(P<0.05)。结论对HSPN尿分析及24h尿蛋白定量均正常的患儿,要密切检测尿微量蛋白,尽早行肾活检,及时治疗,以改善预后。

Objective To explore the importance of early kidney biopsy examination by pathological analysis on the urine small protein analysis and kidney biopsy in 61 children with Henoeh - Schonlein purpura nephritis（HSPN） whose urinalysis and urine protein quantitation detected in each of the 24 hours were normal. Methods The children with HSPN whose urinalysis and urine protein quantitation detected in each of the 24 hours were all normal, either under initial treatment or retreatment, with or without arthrosis, enteron complaint and erythrocyturia under the microscope were selected. All the patients went through tests on their urine small protein. If the results were normal or abnormal during the first examination but became normal again in 1 -2 week, the patient should not be taken for biopsy examination. However, if the results kept on to be abnormal or experienced 3 or more times of abnormal in repetition, the patient should be taken for biopsy examination and his pathological changes shall be observed. The relationship between the urine Alb quantity, urine small protein selectivity and degree of pathological lesion were distinguished from the relationship between the deposition of antigen - antibody complex IgA, IgG and IgM in nephridial tissues and degree of pathological lesion. Results All patients whose urinalysis and urine protein quantitation detected in each of the 24 hours were normal but urine small protein kept on to be abnormal or experienced 3 or more times of abnormal in repetition were taken for biopsy examination. The kidney in all of the cases was involved, in which, there were 26 cases （42.6%） showed Ⅱ a, 10 cases （16.4%） revealed Ⅱ b, 21 cases （34.4%） displayed Ⅲ a, and 4 cases （6.6%） showed Ⅲ b. There was no obvious relationship between the selectivity of small protein in the urine and the extent of renal pathological lesion（ Pa 〉 0.05 ）. With the renal pathological lesion aggravating, the percentage of the co - precipitation of IgA, IgG and IgM in the nephridial tissues increased （ P 〈 0.05 ）. Conclusions Great importance shall be attached to urine small protein analysis in children with HSPN whose urinalysis and urine protein quantitation detected in each of the 24 hours are normal. If the urine small protein analysis is abnormal, these patients should be taken for biopsy examination as early as possible.