儿童紫癜性肾炎和IgA肾病临床病理对比分析

A clinico-pathological comparison between Henoch-Schonlein purpura nephritis and IgA nephropathy in children

目的探讨儿童紫癜性肾炎(HSPN)和IgA肾病在临床和肾脏病理上的异同。方法回顾性分析103例HSPN患儿和61例IgA肾病患儿的临床资料和肾脏病理资料。结果 HSPN患儿与IgA肾病患儿在年龄、性别及病程方面比较差异无统计学意义(P>0.05)。与HSPN患儿比较,IgA肾病患儿临床分型更重,且更易出现肉眼血尿,差异有统计学意义(P<0.05)。IgA肾病患儿的血肌酐及胆固醇水平较HSPN患儿增高,差异有统计学意义(P<0.05)。光镜病理显示HSPN患儿较IgA肾病患儿易出现纤维蛋白原相关抗原沉积,而IgA肾病患儿较HSPN患儿易出现补体C3沉积,且间质纤维化、肾小管管型、肾小管炎症细胞浸润在IgA肾病患儿更常见(P<0.05)。结论儿童HSPN和IgA肾病在临床表现、肾脏病理等方面存在较大差异,这些差异不支持两者为同一疾病的假说。

Objective To study the difference in clinico-pathological features between IgA nephropathy （IgAN） and Henoch-Schonlein purpura nephritis （HSPN） in children. Methods The medical data of 103 children with HSPN and 61 children with IgAN were retrospectively studied. Results There were no significant differences in age, sex and disease course between the HSPN and IgAN groups （ P 〉 0.05 ）. Clinical classification demonstrated that more severe conditions were found in the IgAN group than in the HSPN group and gross hematuria was more common in the IgAN group （ P 〈 0.05 ）. Serum creatinine and cholesterol levels were higher in the IgAN group than in the HSPN group （ P 〈 0.05 ）. Fibrinogenrelated antigen deposition was more common in the HSPN group, while complement 3 （ C3 ） deposition was more common in the IgAN group. Interstitial fibrosis, tubular casts and tubular inflammatory infiltration were also more common in the IgAN group （P 〈 0.05 ）. Conclusions Significant clinieo-pathological differences can be found between HSPN and IgAN in children, and these differences do not support a one disease entity hypothesis.