儿童紫癜性肾炎的临床病理及预后分析

The Analysis of the Clinical and Pathological Characteristics and Prognosis in Children with Henoch-schonlein Purpura Nephritis

目的探讨儿童过敏性紫癜性肾炎（HSPN）的临床、病理类型及其与预后的关系。方法对2003年1月～2009年1月行肾活检的68例HSPN患儿的临床分型、病理分级及预后进行回顾性分析。结果临床分型以血尿和蛋白尿型23例（33．8％）最多见，病理分级以Ⅲ级39例（57．4％）最多见。临床分型中孤立性血尿或孤立性蛋白尿型（I型）、血尿和蛋白尿型（Ⅱ型）预后较好，其次为急性肾炎型（Ⅲ型）及肾病综合征型（Ⅳ型），而急进性肾炎型（Ⅴ型）预后差；病理分级为Ⅱ级预后好于Ⅲ级（P〈0．05），Ⅲa级以下预后良好，Ⅲb级以上预后差（P〈0．05）。结论儿童HSPN临床症状的严重程度与病理损伤的程度基本一致，其预后与临床分型、病理分级密切相关。

Objective To investigate the relationship between the clinical and pathological characteristics and prognosis in children with Henoch-schonlein Purpura Nephritis（HSPN）.Methods 68 children with HSPN performed renal biopsy in our hospital from Jan. 2003 to Jan. 2009 were analysed retrospectively of the clinical type,pathological grade and prognosis.Results Hematuria and proteinunia was the most common clinical type, grade Ⅲ was the most common pathological grade. In clinical types, type Ⅰ and Ⅱ usually had good prognosis, and the prognosis of type Ⅰ and Ⅱ was better than that of type Ⅲ and type Ⅳ（P〈0.05）. The prognosis of type Ⅴ was poor. In pathological grading, the prognosis of grade Ⅱ was better than that of grade Ⅲ（P〈0.05）. Grade less than In a had good prognosis, the prognosis of grade above Ⅲb was poor.Conclusions In children with HSPN, the clinical presentations are almost consistent with the renal pathological injury, and the prognosis is closely associated with the clinical type and pathological grade.