江西地区肾脏病儿童757例肾活检的病理与临床资料分析

Analysis of Pathological Renal Biopsy and Clinical Manifestations among 757 Children with Kidney Diseases in Jiangxi Province

目的探讨儿童肾脏疾病的病理特点及其与临床表现的关系。方法回顾性分析2002年2月-2010年6月在江西省儿童医院行肾活检的757例肾病患儿的病理及临床资料。将肾活检组织分别行光镜、免疫荧光、免疫组织化学及电镜检查。肾活检组织均作苏木精-伊红（HE）、过碘酸雪夫反应（PAS）、六胺银（PASM）及Masson染色;免疫荧光检测IgG、IgA、IgM、C3、C4、C1q。有乙型肝炎病毒感染证据者肾组织同时行乙型肝炎表面抗原（HBsAg）、乙型肝炎e抗原（HBeAg）、乙型肝炎核心抗原（HBcAg）免疫组织化学。参照中华医学会肾脏病分会2000年制定的标准进行病理分型,结合临床和病理资料进行统计分析。结果 1.肾活检病例757例中原发性肾小球疾病537例（70.97%）,其中肾病综合征265例（49.35%）,孤立性血尿99例（18.44%）;继发性肾小球疾病211例（27.84%）,其中紫癜性肾炎144例（68.25%）,乙肝相关性肾炎47例（22.27%）;遗传性肾小球疾病9例（1.19%）。2.原发性肾小球疾病病理类型最多的是系膜增生性肾小球肾炎277例（51.58%）;继发性肾小球疾病中紫癜性肾炎最多,为144例（68.25%）,其病理分级以Ⅱb~Ⅲb为主,占79.17%;遗传性肾小球疾病中A lport综合征8例;薄基底膜肾病1例。结论江西地区儿童肾脏疾病以原发性肾小球疾病为主,病理改变以系膜增生性肾小球肾炎占绝大多数;继发性肾小球疾病中除以紫癜性肾炎为主外,乙肝相关性肾炎并不少见。

Objective To explore characteristics of children with renal diseases and the relationship between pathological features and clinical manifestations.Methods From Feb.2002 to Jun.2010,retrospective analysis was made in 757 patients with renal diseases in Children′s Hospital of Jiangxi Province.The renal biopsy specimens were divided into 3 sections for microscope,immunofluorescence and electron microscope examinations,respectively,and they were processed by hematoxylin-eosin（HE）,periodic acid-schiff（PAS）,periodic acid-sliver methenamine（PASM）,and Masson staining.Immunofluorescence was used to detect the deposition of immunoglobulin G（IgG）,IgA,IgM,complement 3（C3）,C4,and C1q in the renal tissues.Additional examinations were performed to detect hepatitis B surface-antigen（HBsAg）,hepatitis Be antigen（HBeAg）and hepatitis B core antigen（HBcAg）deposition in some cases with positive serum HBsAg.Pathological classification was made according to the criteria of 2000 for renal pathology by Kidney Disease Branch of Chinese Medical Association,and analyzed statistically with the combination of clinical and pathological data.Results 1.Among 757 cases of renal biopsy,there were 537 cases to be primary glomerular disease（70.97%）,211 cases secondary glomerular disease（27.84%）,9 cases hereditary glomerular disease（1.19%） in 757 cases of renal biopsy.Of the primary glomerular disease cases,there were nephrotic syndrome 265 cases（49.35%）,hematuria 99 cases（18.44%）;of secondary glomerular diseases,there were 144 patients with Henoch-Schonlein purpura nephritis（68.25%）,HBV-nephritis in 47 cases（22.27%）.2.The primary glomerulary disease,most of the pathological type：mesangial proliferative glomerulonephritis 277 cases（51.58%）;Henoch-Schonlein purpura nephritis was the most of secondary glomerular disease,144 cases（68.25%）,belonging mainly to pathologic grade Ⅱ b-Ⅲ b,which accounted for 79.17%;there were 8 cases of Alport syndrome in hereditary glome-rulary disease,1 case of thin basement membrane nephropathy.Conclusions Primary glomerulary disease is a kind of common renal diseases in children of Jiangxi Provincie and mesangial proliferative glomerulonephritis is the most common pathological category in children′s primary glomerulary disease.In secondary glomerulary diseases,incidence of Henoch Schonlein purpura nephritis is the highest and HBV-nephritis is the second.