儿童新月体肾炎9例的临床病理特点及预后分析

Clinical and pathological characteristics and prognosis analysis of 9 children with the cresentic nephritis

目的了解儿童新月体肾炎的不同病理程度与临床表现及转归的关系。方法选取本院2008年1月至2015年12月经肾脏活检确诊的9例新月体肾炎患儿,对其临床、病理资料进行回顾性分析,并进行疗效观察及随访。结果在新月体比例50%~75%（A1组）和新月体比例〉75%（B1组）、系膜细胞和基质呈轻中度增生（A2组）和系膜细胞和基质呈中重度增生（B2组）、无间质纤维化组（A3组）和伴有间质纤维化组（B3组）之间,年龄分布、基础24小时尿蛋白量及血肌酐值差异均无显著性。肾功能未恢复组与肾功能恢复组基础尿蛋白量分别为（7.80±0.14）g/d、（3.48±0.91）g/d,两组比较差异有显著性（P=0.001）;两组纤维性新月体比例分别为（60.90±31.68）%、（3.33±8.17）%,两组比较差异有显著性（P=0.003）。结论新月体肾炎发病年龄越小,肾脏病理改变可能越重,临床表现尿蛋白量及血肌酐值可能越高。纤维性新月体比例和基础尿蛋白量可作为评价新月体肾炎预后的指标。

Objective To understand the clinical and pathological characteristics and prognosis of the cresentic nephritis in children. Method A retrospective study was conducted in 9 children admitted to our department from January 2008 to December 2015, with cresentic nephritis proved by renal biopsy,including collect the clinical and pathological data and following up. Result In the proportion of crescentic with 50%~75%（group A1） and the proportion of crescentic with 〉75%（group B1）, mild to moderate hyperplasia of the mesangial cells and matrix（group A2） and moderate to severe hyperplasia（group B2）, no interstitial fibrosis（group A3） and with interstitial fibrosis（group B3）, there were not significant in age, urinary protein and serum creatinine, respectively. Between the groups of not recovered renal function and recovered renal function, urinary protein were（7.80±0.14）g/d,（3.48±0.91）g/d（P=0.001）, respectively; the proportion of fibrous crescent were（60.09±31.68）%,（3.33±8.17）%（P=0.003）, respectively. Conclusion Smaller age of onset of crescentic nephritis, renal pathological may be more severe, urinary protein and serum creatinine may be higher. Fibrous crescents and urinary protein can be used to evaluate the prognosis of crescentic nephritis.