儿童紫癜性肾炎肾脏病理分级与临床特征关系探讨

Relationship between Renal Pathology and Clinical Characteristic in Childhood Henoch-Schnlein Purpura Nephritis

目的探讨儿童紫癜性肾炎肾脏病理分级与年龄分期、免疫荧光分型及临床分型的关系。方法选取2008-01-01—2012-01-01南京军区南京总医院儿科肾穿刺活检病理检查诊断为紫癜性肾炎患儿120例,根据病理检查分为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级;根据年龄分为婴幼儿期、学龄前期、学龄期、青春期;根据免疫荧光分为单纯IgA沉积型、IgA+IgG沉积型、IgA+IgM沉积型、IgA+IgG+IgM沉积型;根据临床分型分为孤立性血尿型、孤立性蛋白尿型、血尿和蛋白尿型、肾病综合征型、慢性肾炎型。分析其病理分级与年龄分期、免疫荧光分型、临床分型的关系。结果 120例患儿均存在皮肤紫癜症状,以双下肢对称性出血性皮疹最多见;伴胃肠道症状82例(68.3%),关节痛62例(51.7%)。均以肾小球弥漫颗粒状IgA伴C3沉积为特点。Ⅰ级3例(2.5%),Ⅱ级51例(42.5%),Ⅲ级62例(51.7%),Ⅳ级4例(3.3%)。不同肾组织病理分级患儿年龄分期间差异无统计学意义(χ2=7.497,P=0.586);不同肾组织病理分级患儿免疫荧光分型间差异有统计学意义(χ2=25.930,P=0.002);不同肾组织病理分级患儿临床分型间差异有统计学意义(χ2=29.557,P=0.003)。结论临床表现严重的紫癜性肾炎患儿肾脏病理分级较重,免疫球蛋白沉积类型较多。

Objective To analyze the relationship between renal pathology,age stages,renal immunofluorescence types and clinical classification in childhood Henoch-Schnlein purpura nephritis（HSPN）.Methods 120 children diagnosed by renal biopsy as HSPN from January 2008 to January 2012 in Nanjing command of Jingling hospital were reviewed.According to pathological types the patients were divided into class Ⅰ,classⅡ,class Ⅲ and class Ⅳ.According to age stages,the patients were divided into infant,preschool,school age,adolescence.According to immunofluorescence deposition,the patients were divided into IgA type,IgA ＋ IgG type,IgA ＋ IgM type and IgA ＋ IgG ＋ IgM type.According to clinical classification,the patients were divided into isolated hematuria,isolated proteinuria,hematuria and proteinuria,nephrotic syndrome and chronic nephritis.The relationship between pathological grade,age stages,immunofluorescence classification and clinical type was analyzed.Results All the 120 patients had skin purpura and the hemorrhagic rash of the lower limbs was the most common seen.82 cases were accompanied with gastrointestinal symptoms（68.3%） and 62 cases were accompanied with arthralgia（51.7%）.The deposition on glomerulus with IgA and C3 were characterized on every case.3 cases were gradeⅠ（2.5%）,51 cases were grade Ⅱ（42.5%）,62 cases were gradeⅢ（51.7%） and 4 cases were gradeⅣ（3.3%）.The difference of histological grade and age stage was not statistically significant（χ2 = 7.497,P = 0.586）,but the difference of histological grade and immunofluorescence types was statistically significant（χ2 = 25.930,P = 0.002）.The difference of histological grade and clinical classification was also statistically significant（χ2 = 29.557,P = 0.003）.Conclusion The more severe of clinical manifestation in purpura nephritis children,the more severe of their renal pathology and types of immunoglobulin deposit.