小儿紫癜性肾炎的临床病理及远期预后分析

Analysis on clinicopathology and long-term prognosis of anaphylatic purpura nephritis in children

目的:探讨小儿紫癜性肾炎(HSPN)的临床病理及远期预后。方法:回顾性分析2000年6月～2009年3月住院治疗的60例小儿HSPN的临床资料,随访6个月～10年,对患儿的临床病理及远期预后进行综合分析。结果:完全恢复病例33例(55.0%),肾功能不全3例(5.0%)。临床分型以血尿和蛋白尿及肾病综合征最常见,两者分别为28例(46.7%)、27例(45.0%);ISKDC病理分型以Ⅱ、Ⅲ级最多,两者分别为29例(48.3%)、28例(46.7%);免疫病理分型以IgA、IgA+IgM最常见,分别为19例(31.7%)、21例(35.0%)。临床分型中孤立性血尿/蛋白尿与血尿和蛋白尿型预后优于肾病综合征及急进性肾炎,差异有统计学意义(P<0.01);病理分级与患者预后显著相关(P<0.01);非尿蛋白肾病水平的患儿预后优于肾病尿蛋白水平者,差别有统计学意义(P<0.01);免疫病理分型与预后无明显关系(P>0.05)。结论:肾病综合征、急进性肾炎、发病时病理类型严重以及持续性的尿蛋白异常提示HSPN远期预后不良,应依据临床病理类型确定HSPN的治疗方案。

Objective： To explore the clinicopathology and long - term prognosis of anaphylatic purpura nephritis in children. Methods： The clinical data of 60 children with anaphylatic purpura nephritis in the hospital from June 2000 to March 2009 were analyzed retrospectively, all the children were followed up for 6 months - 10 years, the clinicopathology and long -term prognosis of the children were analyzed comprehensively. Results： 33 children （55.0%） recovered completely, 3 children （5.0%） developed into renal insufficiency. The most common clinical types were hematuria plus proteinunia and nephrotic syndrome, the percentages were 46.7% （28 children） and 45.0% （27 children） , respectively ; according to ISKDC pathological classification, most of the children were grade II （29 children, 48.3% ） and grade III （28 children, 46. 7% ） ; the most common immune pathological types were IgA （ 19 children, 31.7% ） and IgA ＋ IgM （21 children, 35.0% ） . Among different clinical types, the prognosis of children with isolated hematuria/proteinunia type, hematuria type and proteinunia type was better than that of children with nephrotic syndrome and rapidly progressive glomerulonephritis （ P 〈 0. 01 ） ; pathological grades were correlated with the prognosis significantly （P 〈 0. 01 ） ; the prognosis of children with non - proteinuria nephropathy level was better than that of children with proteinuria nephropathy level （ P 〈 0. 01 ） ; there was no correlation between immune pathological types and prognosis （ P 〉 0.05 ） . Conclusion： Nephrotic syndrome, rapidly progressive glomerulonephritis, severe histopathology during the attack and persistent proteinunia indicate adverse long - term prognosis of children with anaphylatic purpura nephritis, the therapeutic schedule of anaphylatie purpura nephritis should be confirmed according to clinical pathological types.