成人紫癜性肾炎的临床病理分析及转归

The Clinical and Pathological Characteristics and Prognosis in Adults with Henoch-Schonlein Purpura Nephritis

目的:了解深圳地区成人紫癜性肾炎的临床特征及其与肾脏病理的联系;探讨其转归及影响因素。方法:回顾性分析2001年1月～2009年12月间经我院临床及肾活检确诊的紫癜性肾炎52例,对其临床资料、病理特征及转归进行统计分析。结果:(1)成人紫癜性肾炎多好发于30岁以下,40岁以后患者高血压的发生率较高。(2)临床分型以蛋白尿+血尿型(59.6%)最多见,其次为单纯性血尿(21.2%)和肾病综合征型(19.2%);病理分级以Ⅱ级(44.2%)及Ⅲ级(36.5%)多见。(3)肾小管间质病变与肾小球慢性病变及活动病变的相关系数分别为0.587(P<0.01)和0.260(P>0.05);蛋白尿越多的患者,其肾小球活动病变积分就越高。(4)多因素分析显示疗效与肾小球硬化率及肾小管间质病变呈负相关。结论:深圳地区成人紫癜性肾炎发病相对年轻,临床以蛋白尿+血尿型多见,病理以Ⅱ、Ⅲ级常见;蛋白尿的严重程度与肾小球活动病变关系密切;影响疗效的主要因素为肾小球慢性病变及肾小管间质病变程度。

Objective：To discuss the clinical and pathological features in adults with Henoch-Schonlein purpura nephritis（HSPN）,and to evaluate the prognosis predictors.Methods：Clinical,pathological and outcome of records of 52 adults with HSPN from January 2001 to December 2009 were retrospectively reviewed.Results：（1）The majority of patients were under the 30 years old;The incidence of hypertension was higher after 40 years old.（2）Most of patients presented hematuria and proteinunia（59.6%）,and the other exhibited isolated hematuria（21.2%）and nephrotic syndrome（19.2%）;Most of pathological classifications were grade Ⅱ（44.2%）and Ⅲ（36.5%）.（3）There has excellent correlations between tubulointerstionlesions and glomerulor chronic lesions（P0.01）.While there were no singnificant difference between tubulointerstitial lesions and glomerulor active lesions（P0.05）.The severity of proteinuria has excellent correllations with glomerulor actve lesions.（4）A logistic multivariate analysis showed significant correlations between theraputic effects and glomerulor chronic lesions and tubulointerstitial lesions.Conclusion：Most of patients with HSPN in ShenZhen were under the 30 years old and presented hematuria and proteinunia.Grade Ⅱ and Ⅲ of pathological classification have been seen in the majority of HPSN in adults.The severity of proteinuria is a good marker for glomerular active lesions.Glomerulor chronic lesions and tubulointerstitial lesions were confirmed as the affecting factors of influencing theraputic effects.