小儿紫癜性肾炎的临床病理及远期预后分析

Clinical Pathology and Long Term Prognosis of Henoch Schonlein Nephritis in Children

目的 分析小儿紫癜性肾炎的临床、病理与远期预后的关系。方法 比较 32例紫癜性肾炎的临床病理变化 ,随访其中 19例 ,随访期限 8～ 14年 ,了解临床及病理对远期预后的影响。结果 小儿紫癜性肾炎的临床分型中以急性肾炎综合征型多见 ,占 5 0 % ,肾病综合征型次之占 40 % ;病理变化以Ⅱ～Ⅲ级多见。急性肾炎综合征型与肾病综合征型随访比较 ,痊愈率分别为 5 5 .6 % (5 / 9例 )和 2 8.6 % (2 / 7例 ) ;病理分级Ⅰ～Ⅲ级的痊愈率为 43.8% (7/ 16例 ) ,恶化率 12 .5 % (2 / 16例 ) ,Ⅳ～Ⅴ级中 6 6 .7% (2 / 3例 )恶化或死亡。结论 急性肾炎综合征型远期预后较肾病综合征型好 。

Objective To analyze the relationship between the clinical and pathological effects and long term prognosis in children with Henoch Schonlein nephritis. Methods Changes of clinical pathology were studied in 32 children with Henoch Schonlein nephritis and 19 cases of them were followed over an 8 to 14 year period. Results Acute nephritis ranked first (50%) and the nephritic syndrome ranked second (40%) in the clinical classification of Henoch Schonlein nephritis; the majority had pathological changes of Grade Ⅱ～Ⅲ. The rate of recovery of acute nephritis and the nephritic syndrome was 55.6% and 28.6% , respectively. The rate of recovery and deterioration of Grade Ⅰ～Ⅲ pathological changes was 43.8% and 12.5% , respectively. Of the patients with Grade Ⅳ～Ⅴ pathological changes, 66.7% deteriorated or died. Conclusions The prognosis of acute nephritis was better than that of the nephritic syndrome, and long term prognosis is closely associated with the clinical classification and pathology.