儿童紫癜性肾炎血尿酸水平与临床及病理的关系

Relationships of serum uric acid with clinical and pathological manifestations in children with Henoch-Schönlein purpura nephritis

目的研究紫癜性肾炎(HSPN)患儿血尿酸水平与临床指标及病理表现之间的关系。方法回顾分析82例HSPN患儿的临床资料,根据血尿酸水平将患儿分为血尿酸增高组(43例)和血尿酸正常组(39例),分析血尿酸水平与临床指标、病理表现的相关性,并分析不同临床分型HSPN患儿的血尿酸情况。结果与血尿酸正常组相比,血尿酸增高组的24小时尿蛋白量、血肌酐水平、血胆固醇水平较高,而血白蛋白水平、肾小球滤过率较低,差异均有统计学意义(P<0.05)。血尿酸增高组病理分级为I^II级的比例低,新月体形成≥25%的比例高,肾小管萎缩评分为1和2分的比例高,差异均有统计学意义(P<0.05)。孤立性血尿型、孤立性蛋白尿型、血尿和蛋白尿型患儿的血尿酸水平均低于肾病水平蛋白尿型,差异有统计学意义(P<0.05)。结论伴有血尿酸增高的HSPN患儿,尿蛋白增多、肾功能下降以及肾脏病理改变更严重;而肾病水平蛋白尿型患儿的血尿酸水平也较高。血尿酸可能是评估HSPN病情和预后的重要指标之一。

Objective To investigate the relationships of serum uric acid with clinical and pathological manifestations in children with Henoch-Schönlein purpura nephritis(HSPN).Methods The clinical data of 82 children with HSPN were retrospectively analyzed.According to the levels of serum uric acid,these children were divided into hyperuricemia group(43 cases)and normal serum uric acid group(39 cases).The correlation of serum uric acid level with clinical indicators and pathological manifestations was analyzed,and the serum uric acid levels of children with different clinical subtypes of HSPN were analyzed.Results Compared with the normal uric acid group,the 24-hour urinary protein content,serum creatinine level and blood cholesterol level were higher in the hyperuricemia group,while the serum albumin level and glomerular filtration rate were lower in the hyperuricemia group.The differences were statistically significant(P<0.05).Compared with the normal uric acid group,the proportion of pathological gradingⅠtoⅡwas lower,the proportion of crescent formation≥25%was higher,and the proportion of renal tubular atrophy score of 1 and 2 was higher in the hyperuricemia group.The differences were statistically significant(P<0.05).The serum uric acid level of the children with isolated hematuria,isolated proteinuria,hematuria and proteinuria was lower than that of the children with nephrotic proteinuria,and the difference was statistically significant(P<0.05).Conclusions Children with HSPN having increased serum uric acid were more severe in increased urinary protein,decreased renal function and renal pathological changes.Serum uric acid levels were also higher in children with nephrotic proteinuria.Serum uric acid may be one of the important factors in the assessment of HSPN condition and prognosis.