小儿毛细血管内增生性IgA肾病38例临床与病理分析

Clinicopathology of 38 cases of endocapillary proliferative IgA nephropathy in children

目的探讨毛细血管内增生性IgA肾病患儿临床与病理之间的关系。方法选择38例肾脏病理诊断为毛细血管内增生性IgA肾病的患儿，分为肾病综合征组和非肾病综合征组以及轻、中、重度内皮细胞增生组，对其尿常规、尿蛋白定量、血清白蛋白等进行检测，对其肾组织中内皮细胞和系膜细胞增生程度进行评分。结果（1）肾病综合征组与非肾病综合征组比较，内皮细胞增生指数偏高，而系膜细胞增生指数无差异。（2）重度与轻度内皮细胞增生组比较，在前驱感染率、肉眼血尿发生率以及尿蛋白好转率上均存在差异，轻、中、重度内皮细胞增生组之间24h尿蛋白定量上均有差异。结论 在小儿毛细血管内增生性IgA肾病患者中，呈肾病综合征表现者有更严重的内皮细胞增生，而其增生程度的轻重与临床中蛋白尿的多寡有关，镜下血尿与内皮细胞增生程度无关，感染似乎是小儿毛细血管内增生性IgA肾病患者发生肉眼血尿的更主要影响因素。

Objective To explore the clinicopathologic relationship in children with endocapillary proliferative IgA nephropathy. Methods Thirty-eight children with endocapillary proliferative IgA nephropathy diagnosed pathologically were divided into nephrotic syndrome group and the group without nephrotic syndrome, and mild, moderate and severe endothelial cell proliferation groups. The routine test of urine and urinary albumin quantification were done. Serum albumin level was determined, and the proliferation of endothelial cells and mesangial cells in renal tissue was measured. Results En- dothelial cell proliferation index was slightly higher in nephritic syndrome group than in the group without nephritic syndrome, but there was no significant difference in the mesangial cell proliferation index. There was significant difference in prodromal infection rate, gross hematur[a incidence and 24- h urinary protein quantification among three endothelial cell proliferation groups. Conclusions The nephritic syndrome has a more serious endothelial cell proliferation in the children with endocapillary proliferative IgA nephroathy. There is a correlation between the severity of hyperplasia and proteinuria. The microscopic hematuria had no correlation with severity of endothelial cell proliferation. The infection may he the main influencing factors for gross hematuria in the children with endocapillary proliferative IgA nephropathy.