病初伴有肉眼血尿紫癜性肾炎患儿临床和病理特征分析

Clinical and pathological features of Henoch-Schonlein purpura nephritis with macrohematuria at the early disease stage

目的探讨紫癜性肾炎(henoch-schonlein purpura nephritis,HSPN)病初伴有肉眼血尿患儿的临床及病理特征。方法回顾性分析2016年1月至2019年6月初诊于河北医科大学附属河北省儿童医院确诊为HSPN且行肾穿刺活检术的患儿,根据病初伴或不伴肉眼血尿分为2组,比较患儿临床及病理特征。结果研究纳入87例HSPN患儿,病初伴有肉眼血尿27例,其余60例患儿为对照组。2组在年龄、性别及病程上均无统计学差异。肉眼血尿组血肌酐、IgA及IgA/C3水平明显高于对照组,C3及血清白蛋白明显低于对照组,两组差异有统计学意义(P<0.05)。伴随症状(合并肢体肿痛、腹痛、前驱感染)及24h尿蛋白定量方面,2组比较差异无统计学意义(P>0.05)。病理方面,肉眼血尿组慢性指标小血管壁增厚明显低于对照组(P<0.05),但活动性指标细胞性新月体明显高于对照组,差异有统计学意义(P<0.05),肉眼血尿组免疫荧光C3阳性比例较对照组明显增高,差异有统计学意义(P<0.05),其余系膜细胞、内皮细胞增生,肾小球节段、球性硬化,肾小管间质萎缩、炎性细胞浸润及免疫荧光IgG、IgM沉积差异无统计学意义(P>0.05)。结论病初伴有肉眼血尿的HSPN患儿临床血白蛋白明显减低,血肌酐升高,免疫指标IgA、C3及IgA/C3变化明显,病理提示小血管壁增厚较轻,细胞性新月体活动性病变及补体C3沉积更明显。

Objective To investigate the clinical and pathological characteristics of Henoch-Schonlein purpura nephritis(HSPN)with macrohematuria at the early diseases stage.Methods The children,who were diagnosed with HSPN ad underwent puncture biopsy in Hebei Province Children’s Hospital Affiliated to Hebei Medical University from January 2016 to June 2019 were analyzed retrospectively.According to the children with or without macrohematuria,they were divided into two groups,and their clinical and pathological characteristics were compared between the two groups.Results A total of 87 children with Henoch Schonlein purpura nephritis were included in the study.Among them,27 children had macrohematuria at the early disease stage,and the other 60 ones were in the control group.There were no statistically significant differences in age,gender and course of disease between the two groups.The levels of serum creatinine,IgA and IgA/C3 in the macrohematuria group were significantly higher than those in the control group,and C3 and serum albumin were significantly lower than those in the control group,with statistically significant differences(P<0.05).There were no statistically significant differences between the two groups in terms of accompanying symptoms(with swelling and pain of limbs,abdominal pain,prodromic infection)and 24-hour urine protein(P>0.05).In terms of pathology,the chronic index of thickening of small vessel walls in the macrohematuria group was significantly lower(P<0.05),the active index of cellular crescents was significantly higher than that in the control group,with statistically significant differences(P<0.05).The C3-positive rate in immunofluorescence assay in the macrohematuria group was significantly higher than that in the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in the proliferation of other mesangial cells and endothelial cells,glomerular segments,glomerular sclerosis,renal tubulointerstitial atrophy,inflammatory cell infiltration and immunofluorescence IgG and IgM deposition(P>0.05).Conclusion The Henoch Schonlein purpura nephritis children with macrohematuria at the early disease stage show significantly decreased serum albumin,increased serum creatinine,and significantly changed immune indexes IgA,C3 and IgA/C3.The biopsy pathology suggests that the chronic index of small vessel wall thickening is lower,the active lesions of cellular crescents and the deposition of complement C3 are more obvious.