紫癜性肾炎伴高血压患儿临床病理特征及预后分析

Analysis of clinical pathological features and prognoses of children with Henoch-Sch nlein purpura nephritis with hypertension

目的分析过敏性紫癜性肾炎(henoch-Schonlein purpura nephritis,HSPN)伴高血压患儿临床和病理特征及预后特点。方法对2015年1月至2019年12月贵阳市妇幼保健院住院诊断为HSPN的148例患儿的临床及病理资料进行回顾性分析,根据患儿是否合并高血压分为HSPN血压正常组和HSPN伴高血压组,分析比较两组患儿临床病理特征及预后的差异。结果(1)148例HSPN患儿中血压正常105例(70.9%),伴高血压43例(29.1%),两组患儿在性别、年龄、起病时间上差异无统计学意义。(2)高血压组患儿夜间高血压发生率明显大于日间高血压发生率(χ^(2)=9.446,P<0.05)。两组患儿异常血压类型(非杓型及反杓型血压)发生率分别为79.1%、77.1%,差异无统计学意义。(3)高血压组24 h尿蛋白定量、尿微量白蛋白、血肌酐、血总胆固醇程度较血压正常组严重,差异有统计学意义(P<0.05),而血补体C3、血白蛋白、血小板计数差异无统计学意义。(4)高血压组临床分型以肾病综合征型为主,较血压正常组重,差异有统计学意义(χ^(2)=35.470,P<0.01)。高血压组病理分型均为Ⅲ型及Ⅲ型以上,较血压正常组重,差异有统计学意义(χ^(2)=25.642,P<0.01)。(5)与血压正常组比较,高血压组预后较差,差异有统计学意义(χ^(2)=6.663,P<0.05)。结论HSPN伴高血压患儿以夜间血压升高为主,其临床分型和病理分型较HSPN血压正常患儿严重,肾脏预后较差,应重视HSPN伴高血压患儿血压管理,改善患儿预后。

Objective To explore the clinicopathological features and prognoses of children with Henoch-Sch nlein purpura nephritis(HSPN)with hypertension.Methods From January 2015 to December 2019,clinicopathological data of 148 HSPN children were retrospectively analyzed.According to whether or not there was a complication of hypertension,they were divided into the groups of HSPN with normal blood pressure(n=105,70.9%)and HSPN with hypertension(n=43,29.1%).The clinicopathological features and prognoses of two groups were compared.Results No significant inter-group difference existed in gender,age or onset time.The incidence of nocturnal hypertension was significantly higher than that of daytime hypertension in hypertension group(χ^(2)=9.446,P<0.01).And the incidence of abnormal blood pressure(non-dipper BP&reversed dipper BP patterns)was 79.1%and 77.1%in two groups respectively and the difference was statistically insignificant.Compared with normal blood pressure group,24-hour urinary protein quantity,degree of urinary microalbumin,serum creatinine and total cholesterol in hypertension group were more severe than those in normal blood pressure group and the difference was statistically significant(P<0.05).However,no significant difference existed in blood complement C3,serum albumin or platelet count.Nephrotic syndrome was a predominant clinical type in hypertension group and it was more severe than that in normal blood pressure group.And the difference was statistically significant(χ^(2)=35.470,P<0.01).The pathological classification of hypertension group was typeⅢand above and it was more severe than that of normal blood pressure group.And the difference was statistically significant(χ^(2)=25.642,P<0.01).As compared with normal blood pressure group,the prognosis of hypertension group was worse and the difference was statistically significant(χ^(2)=6.663,P<0.05).Conclusions HSPN children with hypertension is mostly characterized by elevated blood pressure at nighttime.The clinicopathological types are more severe than those with normal blood pressure in HSPN and the prognosis of kidney is worse.For HSPN children with hypertension,physicians should focus upon managing blood pressure and improving the prognosis of children.