儿童肾病综合征病理类型与年龄、性别的关系

Age and geader in pathological typing of 1116 children with nephrotic syndrome

目的探讨肾病综合征患儿的肾脏病理和性别、年龄分期的关系。方法对1 116例经肾穿刺活检明确肾脏病理的原发性肾病综合征患儿临床资料进行回顾性分析。结果 1 116例患儿中男817例,女299例,男女比例2.73∶1;平均年龄(7.3±3.3)岁,其中婴幼儿期90例,学龄前期294例,学龄期409例,青春期323例。肾脏病理轻微病变(MCNS)222例,占19.9%;系膜增生性肾小球肾炎(MsPGN)726例,占65.1%;膜增生性肾小球肾炎(MPGN)55例,占4.9%;膜性肾小球肾炎(MN)27例,占2.4%;局灶节段硬化性肾小球肾炎(FSGS)86例,占7.7%。肾脏病理类型在4个年龄分期的分布差异有统计学意义,MCNS患儿以学龄前期最多,MsPGN患儿以学龄期最多,MPGN和MN患儿以青春期最多,FSGS的患儿以学龄期最多。MCNS患儿的男女比例为5.3∶1,MsPGN为2.4∶1,MPGN为0.96∶1,MN为3.5∶1,FSGS为2.7∶1,肾脏病理类型在性别上的分布差异有统计学意义(P<0.05)。结论对于无法开展肾活检的医院或有肾穿刺禁忌证的患儿,可根据年龄和性别结合临床检验初步推断肾脏病理变化的轻重,进一步指导治疗、判断预后。

Objective Renal pathological types of 1 116 children suffering from primary nephrotic syndrome from March 1992 to March 2010 in Nanjing General Hospital of Nanjing Military Command were reviewed.Relationship between renal pathology and age or gender in these children was analyzed.Methods Renopuncture was performed to 1 116 children with primary nephrotic syndrome to identify pathological types.According to the age,those children were divided into four groups：infancy,pre-school age,school age and adolescence.Different distribution of renal pathological types among age stage and gender were analyzed.Results Of total 1 116 patients,817 were boys and 299 were girls（M ∶ F = 2.73 ∶ 1）.The mean age was（7.3 ± 3.3）yrs.Ninety cases were infants,294 cases were pre-school age,409 cases were school age,323 cases were adolescence.Among them,minimal change diseases（MCNS）was found in 222 cases（19.9%）,mesangial proliferative glomerulonephritis（MsPGN）were in 726 cases（65.1%）,membra-noproliferative glomerulonephritis（MPGN）were in 55 cases（4.9%）,membranous nephropathy（MN）were in 27 cases（2.4%）,focal segmental glomerulosclerosis（FSGS）were in 86 cases（7.7%）.The distribution of renal pathological types was significantly different in four age stages.MCNS mostly appeared in pre-school age.MsPGN and FSGS were most common in school age.Both MPGN and MN were more among adolescence.Renal pathological types were also significantly different between genders.Male to female ratio of MCNS patients was 5.3 ∶ 1,of MsPGN was 2.4 ∶ 1,of MPGN was 0.96 ∶ 1,of MN was 3.5 ∶ 1,and of FSGS was 2.7 ∶ 1.Conclusions When renopuncture can＇t be performed,practitioners may deduce the renal pathological change according to a patient＇s age,gender and clinical data to make a medical therapy.