成年与未成年紫癜性肾炎患者的临床和病理表现比较

Comparison of clinicopathological features of Henoch-Schnlein purpura nephritis between adults and juveniles

目的比较成年与未成年紫癜性肾炎(HSPN)患者临床和病理表现的不同特点。方法选取2002-2012年于复旦大学附属华山医院、无锡市人民医院住院并经肾活组织检查确诊的成年HSPN患者154例(成年组)和于2009-2013年于复旦大学附属儿科医院、无锡市人民医院住院并经肾活组织检查确诊的未成年HSPN患者90例(未成年组),比较成年组与未成年组患者的临床表现、实验室和组织病理学检查结果。结果成年组中有上呼吸道感染或进食海鲜等诱因(21.4%)、腹痛(29.2%)、肉眼血尿(4.5%)、血清IgM升高(3.3%)、血清IgA升高(14.6%)的构成比显著低于未成年组(38.9%、50.0%、18.9%、14.3%、42.1%,P值均<0.01),而皮疹反复发作>1年(32.5%)、高血压(22.7%)、肾损伤(32.7%)的构成比均显著高于未成年组(15.6%、6.7%、8.5%,P值分别<0.01、0.05)。两组患者均有系膜细胞增生表现(100%),但成年组节段硬化(37.0%)、间质纤维化(45.5%)、小管萎缩(50.6%)、毛细血管内增生(39.0%)、毛细血管壁改变(24.0%)、动脉硬化(19.5%)、单纯IgA沉积(53.2%)的构成比均显著高于未成年组(15.6%、21.1%、12.2%、15.6%、3.3%、1.1%、32.2%,P值均<0.05),而IgA+IgM沉积(35.7%)、IgA+IgM+IgG沉积(9.1%)、IgA+IgG沉积(1.9%)的构成比均显著低于未成年组(50.0%、11.1%、4.4%,P值均<0.05)。两组间临床分型构成的差异无统计学意义(P>0.05),均以肾炎综合征为主,其次为肾病综合征,单纯血尿者较少。结论成年HSPN患者的临床和病理表现均较未成年患者严重,提示其预后可能较差。

Objective To compare the clinicopathological characteristics of Henoch-Schbnlein purpura nephritis （HSPN） between adults and juveniles. Methods In this retrospective study, 154 adult HSPN patients diagnosed by renal biopsy and treated in Huashan Hospital of Fudan university and Wuxi people＇ s hospital between 2002 and 2012 were enrolled in the adult group, and 90 juvenile HSPN patients diagnosed by renal biopsy and treated in Children＇s Hospital of Fudan university and Wuxi people＇s hospital were in juvenile group. Clinical manifestation, laboratory and tissue examination were compared between the two groups. Results The proportion of causes such as upper respiratory tract infection or eating seafood （21. 4%）, abdominal pain （29.2%）, gross hematuria （4. 5%）, elevated serum IgM （3. 3%） and IgA （14. 6%） in adult group were significantly lower than those in the juvenile group （38.9%, 50.0%, 18.9%, 14.3%, 42. 1%, all P〈0.01 ）, whereas the incidences of rash duration more than 1 year （32.5%）, hypertension （22.7%） and renal function insufficiency （32.7%） in adult group were significantly higher than those in juvenile group （15. 6%, 6. 7%, 8.5%, P〈0. 01 or 0.05）. Mesangial proliferation was found in all adult and juvenile patients. But in adult patients, segmental sclerosis （37.0%）, interstitial fibrosis （45. 5%）, tubular atrophy （50. 6%）, capillary hyperplasia （39.0%）, change of capillary wall （24.0%）, arteriosclerosis （19.5%） and pure IgA deposition （53.2 % ） were more frequently performed than those in juvenile patients （ 15.6 %, 21. 1%, 12.2 %, 15.6 %, 3.3%, 1.1%, 32.2%, all P〈 0.05）. The incidences of deposition of IgA＋IgM （35.7%）, IgA＋lgM＋lgG （9.1%）, IgA＋ IgG （1.9%） in adult patients were significantly lower than those in juvenile patients （50.0%, 11.1% ,4.4%, all P〈0. 05）. There was no significant difference in clinical classification of HSPN between two groups （ P〉0. 05）. The most common manifestation was nephritic syndrome followed by nephrotic syndrome secondly and simple hematuria was seldom seen. Conclusion Either clinical or pathological manifestation in adult HSPN is severer than that in juveniles, which indicates a worse prognosis in adults.