大量蛋白尿表现的儿童IgA肾病和紫癜性肾炎的临床病理比较

Analysis Clinical and Pathological Comparison of IgA Nephropathy and Henoch-Schnlein Purpura Nephritis with High-grade Proteinuria in Children

目的对比研究临床大量蛋白尿表现的IgA肾病(IgA nephropathy,IgAN)和儿童紫癜性肾炎(HenochSchnlein purpura nephritis,HSPN)的临床和肾脏病理改变的异同。方法收集大量蛋白尿表现的26例IgAN和41例HSPN患儿的临床资料和病理资料并进行回顾性分析。结果大量蛋白尿表现的IgAN患儿和HSPN患儿在年龄、性别方面比较差异无统计学意义(P>0.05)。与大量蛋白尿的HSPN患儿相比较,大量蛋白尿的IgAN更易出现血尿(P<0.05),24h尿蛋白、血胆固醇水平更高,血白蛋白更低(P<0.05),临床表现更重。有大量蛋白尿的IgAN患儿和HSPN患儿肾脏免疫复合物沉积比较差异无统计学意义(P>0.05),但IgAN患儿较HSPN患儿在肾小球硬化、肾小管炎症细胞浸润、肾小管萎缩和间质纤维化方面更常见(P<0.05)。结论大量蛋白尿表现的的IgAN比HSPN患儿临床表现重,病理改变更趋慢性化。

Objective To compare the clinical and pathological charactersistics with IgA nephropathy （IgAN）and He- noch- Schoenlein purpura nephritis （HSPN）with proteinuria in children. Methods 26 cases of IgAN and 41 cases of HSPN with high-grade proteinuria in children were retrospectively collected and analyzed. Results There were no significant differences in age and sex between the IgAN and HSPN with high-grade proteinuria groups（ P 〉 0. 05 ）. Hematuria was more common in the IgAN group than in the HSPN group （P 〈 0. 05 ）. In IgAN group ,24-hour urine protein and serum cholesterol levels were higher than that in HSPN group（ P 〈 0. 05 ）, and serum albumin level was lower than that in HSPN group（ P 〈 0.05 ）. There was no statistical significance in IgAN group and HSPN group with renal immune complex deposition difference （ P 〉 0. 05 ）. But in IgAN group, glomerular sclerosis, renal inflammatory cell infiltration, tubular atrophy and interstitial fibrosis were more common than that in HSPN group（P 〈 0. 05 ）. Conclusion The clinical manifestation of IgAN with high-grade proteinuria were heavier than HSPN with high-grade proteinuria in children, and more chronic pathological in children with IgAN with high-grade proteinuria.