80例过敏性紫癜肾炎的临床病理分析

Clinical and Pathological Analysis in 80 Patients with Henoch-Schnlein Purpura Nephritis

目的通过对80例紫癜性肾炎患者的临床病理分析,探讨过敏性紫癜患者的临床表现和肾脏病理的联系。方法对80例紫癜性肾炎患者的临床及病理资料进行回顾性分析和研究。结果大多数患者(68.75%)紫癜性肾炎发生于紫癜发生后1个月内。33.75%的患者发病前有感染史。临床分组中以血尿与蛋白尿型者最多(35例,占43.75%),其次为肾病综合征型(28例,占35%)和急性肾炎型(13例,占16.25%),孤立性血尿或孤立性蛋白尿组仅有3例,占3.75%,急进性肾炎型仅有1例。肾脏病理分型以II型最多(29例,占36.25%),其次是III型(25例,占31.25%),其余依次为VI型(13例,占16.25%)、I型(7例,占8.75%)、IV型(3例,占3.75%)、V型(3例,占3.75%)。免疫复合物多沉积于肾小球系膜区,以单纯IgA沉积为主,占53.75%。结论紫癜性肾炎病理改变以II、III型为主;临床表现与病理分级有关(P<0.05),临床表现越重者,病理表现也越重,但临床表现与免疫复合物沉积水平无相关性(P>0.05)。

Objective We analysed the materials of 80 patients with Henoch-Schnlein purpura nephritis（HSPN） to study the relationship between the clinical and pathological characteristics.Methods We retrospectively reviewed the clinical and pathological information of 80 patients with HSPN.Results A majority of patients（68.75%） appeared nephritis within a month after the purpura.33.75% of the patients had evidences of preceding infections.The most common clinical manifestition is hematuria and proteinuria group（35 cases,43.75%）,and secondly nephrotic syndrome group（28 cases,35%）and thirdly acute nephtitis group（13 cases,16.25%）.Solitary hematuria or proteinuria group has only 3 cases（3.75%）,and rapidly progressive glomerulonephritis（RPGN） group has only one case.The most common pathological classification was gradeⅡ（29 cases,36.25%）,secondly grade Ⅲ（25 cases,31.25%）.The rest in a descending order are grade VI（13 cases,16.25%）,grade I（ 7 cases,8.75%）,grade IV（3 cases,3.75%）,grade V（3 cases,3.75%）.The immune complexes mainly deposit on the glomerular mesangium and 53.75% of the deposition is simply IgA.Conclusion The pathological changes of HPSN patients are mainly grade Ⅱand Ⅲ,and the clinical manifestations are closely associated with pathological classification（P = 0.05 ）.Patients with more serious clinical manifestitions have more serious pathological changes.However,clinical manifestitions have no relationship with immune complex deposition（P 0.05）.