成人与儿童紫癜性肾炎的临床病理特点及预后分析

Comparison of Childhood and Adult HSPN in Clinical Features,Pathological Changes and Prognosis

目的:探讨成人与儿童紫癜性肾炎的临床病理特点及疾病转归的差异。方法:收集温州医学院附属第一医院肾内科住院确诊为紫癜性肾炎(HSPN)的成人患者(≥18岁)36例,38例紫癜性肾炎患儿为温州医学院附属儿童医院住院病人,分析比较二者的临床病理改变及疾病的转归。结果:(1)所有患者均有血尿。成人紫癜性肾炎临床分型为单纯性血尿2例,血尿+蛋白尿23例,肾病综合征11例;儿童患者单纯性血尿6例,血尿+蛋白尿22例,肾病综合征10例;两组比较无统计学差异(P>0.05)。成人紫癜性肾炎合并高血压14例,合并肾功能损害9例;而所有儿童患者均无高血压或肾功能损害。(2)成人紫癜性肾炎病理分级:Ⅰ级3例、Ⅱ级2例、Ⅲ级28例、Ⅴ级2例、Ⅵ级1例,而儿童患者Ⅱ级31例、Ⅲ级7例,两组比较具有统计学差异(P<0.001)。(3)27例成人紫癜性肾炎患者随访结果A组10例、B组14例、C组3例,30例儿童紫癜性肾炎的随访结果A组15例、B组13例、C组2例,两组预后无统计学差异(P>0.05)。结论:成人与儿童紫癜性肾炎临床分型以血尿+蛋白尿最多见,与儿童患者相比,成人临床表现偏重,合并高血压及肾功能损害较多见。成人紫癜性肾炎病理分级以Ⅲ级多见,而儿童病理分级以Ⅱ级多见,提示成人紫癜性肾炎病理较儿童严重。在本研究观察期内,我们发现成人与儿童紫癜性肾炎的预后均较好,二者预后无统计学差异。

Objective： To investigate the differences between adult HSPN and childhood HSPN in clinical features, pathological changes and prognosis. Methods： The study included 36 adult HSPN patients from the First Affiliated Hospital of Wenzhou Medical College and 38 children with HSPN from the affiliated children＇ s Hospital of Wenzhou Medical College. The differences between the two groups in clinical features, pathological changes and prognosis were studied. Results： （1）All patients manifested as hematuria. 2 eases of simple hemamria, 23 cases of hematuria plus proteinuria and 11 cases of nephrotic syndrome, were in adult HSPN, respectively, versus 6 cases, 22 cases and 10 cases in childhood HSPN（ P 〉 0.05）. Adult HSPN patients combined with hypertension were 14 cases and 9 cases with damaged renal function. All childhood HSPN had no hypertension and renal function damage. （2）According to ISKDC pathological classification：3 cases were grade Ⅰ , 2 cases were grade Ⅲ , 28eases were grade Ⅲ, 2 cases were grade Ⅴ and 1 case was grade Ⅵ in adult HSPN group;31 cases in grade Ⅱ and 7 cases grade Ⅲ in Childhood HSPN group（P〈0.001）. （3） In the follow-up, 10 cases were A group, 14 cases were B group, 3 cases were C group in adult HSPN, respectively, versus 15 cases, 13 cases and 2 cases in childhood HSPN（P 〉 0.05）. Conclusion：The manifestation of hematuria plus proteinuria was the most common in both adult HSPN and childhood HSPN. Compared with that of childhood HSPN, the clinical and pathologic manifestation of adult HSPN was more serious. Adult HSPN patients have the same prognosis compared with childhood HSPN patients.