云南地区儿童难治性肾病综合征31例肾穿刺检查分析

An Analysis of 31 Cases of Renal Biopsy Examination of Children with Refractory Nephrotic Syndrome in Yunnan

目的:了解云南儿童难治性肾病综合征患儿的肾组织活检类型。方法:总结2005年至2009年治疗的有完整肾穿刺病理检查结果的原发于肾小球的难治性肾病综合征患儿31例,年龄5～14岁,病程5月～5年的肾组织活检报告,并进行分析。结果:31例肾组织活检病理类型,弥漫性系膜增生性肾炎占35.5%,局灶性增生性肾炎占19.4%,局灶节段肾小球硬化及玻璃样变占16.1%,IgA肾病占12.9%,IgM肾病占6.5%,膜增殖性肾炎(Ⅱ)占6.5%,膜性肾病(Ⅰ～Ⅱ)占3.2%;31例电镜下均见电子致密物沉积;免疫荧光检查,毛细血管颗粒状沉积物(+)4例,(++)16例,系膜团块状沉积物(++)8例,(+++)3例。提示肾组织免疫损害较重,预后差。结论:云南儿童难治性肾病类型以弥漫性系膜增生性肾炎占首位,与国内资料基本相符。对患儿开展肾穿刺对指导临床诊治及预后判断非常重要。

Objective：To investigate the type of renal biopsy of children with refractory nephrotic syndrome in Yunnan province.Methods：The renal biopsy reports from 2005 to 2009 of 31 children aged from 5 to 14 with refractory nephrotic syndrome which was primarily developed from glomerular were summarized and analyzed,and all patients,with a course of disease from 5 month as the shortest to 5 years as the longest,had sound results of pathological examination of renal puncture.Results：The pathologic types of the 31 renal biopsy were：diffuse mesangial proliferative glomerulonephritis accounting for 35.5%,focal proliferative glomerulonephritis accounting for 19.4%,focal segmental glomerular sclerosis and hyalinization accounting for 16.1%,IgA nephropathy accounting for 12.9%,IgM nephropathy accounting for 6.5%,mesangial proliferative glomerulonephritis（Ⅱ）accounting for 6.5%,membranous nephropathy（Ⅰ～Ⅱ）accounting for 3.2% respectively.Electron-dense material deposition could be observed with the immunofluorescence examination in all the 31 cases：capillary granular sediment was（＋）in 4 cases and（＋＋）in 16 cases,and mesangial clumping deposits was（＋ ＋）in 8 cases and（＋ ＋ ＋）in 3 cases,which prompted that there was heavy damage on renal immune and the prognosis was not desirable.Conclusions：Diffuse mesangial proliferative glomerulonephritis was the main pathologic type,and renal puncture examination is of essential importance in treatment and prognosis of refractory nephrotic syndrome.