小儿紫癜性肾炎与IgA肾病临床病理转归对比分析

Comparative analysis of clinico-pathological findings and outcome of Henoch-Schonlein nephritis and IgA nephropathy.

目的：比较紫癜性肾炎（ＨＳＰ肾炎）与ＩｇＡ肾病临床表现、病理改变及疾病转归。方法：对ＨＳＰ肾炎２７例与ＩｇＡ肾病１７例，分别随访（４６±１８）和（２４±１２）个月。结果：发现两者都以单纯性血尿者居多，分别有１０例和８例，而表现为肾炎或肾病综合征均接近５０％；肾脏病理均以不同程度的系膜增生伴肾小球硬化或（和）新月体形成。ＨＳＰ肾炎属Ⅲ～Ⅴ级病变１６例（占５９３％），较ＩｇＡ肾病的８例（占４７１％）明显为多。虽ＨＳＰ肾炎病变较重，但转归明显优于ＩｇＡ肾病。随访结果（分４类：Ａ：正常，Ｂ：轻微尿异常，Ｃ：活动性肾脏病，Ｄ：肾功能不全），ＨＳＰ肾炎２６例得到随访，（另１例失访）属Ｃ者仅１例（３８％），而ＩｇＡ肾病１４例得到随访（另３例失访）属Ｃ、Ｄ者，有３例（２１％）。结论：ＨＳＰ肾炎与ＩｇＡ肾病临床病理及预后的差别有显著性意义（Ｐ＜００１）。

Objective:To compare the clinico-pathological findings and prognosis of the disease.Method:27 cases of Henoch-Schonlein nephritis(HS-N) and 17 cases of IgA nephropathy (IgA-N) were studied;they were followed up for (46±18) months and (24±12) months respectively.Results:Most of them were manifested as asymptomatic hematuria(10 out of 27 in HS-N and 8 out of 17 in IgA-N),about half of them presented as nephritis or nephrotic syndrome.Pathological findings according to the extent of mesangial cell proliferation or(and) crescentic formation,HS-N were classified as grade Ⅲ-Ⅴ in 16(293%) and IgA-N in 8(47.1%).At the end of the followed-up period,inspite of the pathologic changes were severe in HS-N,the outcome were better than that of IgA-N.They were divided as A:normal,B:minimal abnormal urine findings,C:active nephropathy,D:renal insufficiency.26 out of 27 HS-N were followed up,only one was in the status of C,while 3 out of 14 in IgA-N were in the status of C and D.Conclusion:The outcome were significantly different between HS-N and IgA-N.