108例儿童原发性IgA肾病临床与病理分析

Clinical and pathological analysis on 108 childhood patients with primary IgA nephropathy

目的:探讨IgA肾病患儿的临床表现与病理分级关系。方法:通过分析医院行肾脏穿刺术诊断为IgA肾病的108例患儿的临床分级、血尿及蛋白与病理分级的关系。结果:IgA肾病患儿男性多见,男女比例为2.48:1,呼吸道感染为主要诱因。临床分型中血尿(包括肉眼血尿和镜下血尿)和蛋白尿型最多,有45例(41.67%),病理分型以Ⅱ、Ⅲ级(93.33%)为主;其次是急性肾小球肾炎型,有26例(24.07%),病理分型以Ⅱ、Ⅲ级为主(76.92%);肾病综合征型24例(22.22%),病理分型以Ⅲ、Ⅳ级为主(87.5%);孤立性血尿型12例(11.11%),以Ⅰ、Ⅱ级为主(83.33%);孤立性蛋白尿仅1例(0.93%),病理分级为Ⅳ级;未见急进型肾炎和慢性肾炎型。血尿及蛋白尿程度与病理分级相关(P<0.05)。结论:IgA肾病的病理分级与临床分型、血尿及蛋白尿密切相关,尤其是蛋白尿提示肾脏病变相对较重,IgA肾病若不经治疗,最终可能会缓慢进展为终末期肾病,早期诊断,尽早干预是十分有效的防治方法。

Objective:To discuss the clinical and pathological characteristics of childhood patients with IgA nephropathy.Methods:The relationship between clinical grading,hematuria,protein and pathological grading of 108 children diagnosed with IgA nephropathy by renal puncture in Hospital was analyzed.Results:Children with IgA nephropathy were more common in males,with a male to female ratio of 2.48:1,and respiratory tract infections were the main causative factor.The most frequent clinical typing was hematuria(including carnituria and microscopic hematuria)and proteinuria,with 45 cases(41.67%),and the pathological typing was mainly gradeⅡandⅢ(93.33%);followed by acute glomerulonephritis,with 26 cases(24.07%),and the pathological typing was mainly gradeⅡandⅢ(76.92%).24 cases(22.22%)of nephrotic syndrome type,whose pathological grading was mainly gradeⅢandⅣ(87.5%),12 cases(11.11%)of isolated hematuria type,of which grade I andⅡ(83.33%)were predominant;only 1 case(0.93%)of isolated proteinuria,whose pathological grading was gradeⅣ.No acute progressive nephritis or chronic nephritis type was seen.The degree of hematuria and proteinuria correlated with pathological grading(P<0.05).Conclusion:The pathological grading of IgA nephropathy is closely related to the clinical classification,hematuria and proteinuria,especially proteinuria,which indicates that the renal disease is relatively serious.IgA nephropathy is a chronic progressive disease.Early detection and intervention are the best methods to prevent children with IgA nephropathy from progressing to end-stage renal disease.