血尿酸水平与紫癜性肾炎患儿临床及病理的关系

Relationship Between Serum Uric Acid Level and Clinical and Pathological Features in Children with Henoch Schonlein Purpura Nephritis

目的:探讨紫癜性肾炎(henoch-schonlein purpura nephritis,HSPN)患儿血尿酸水平与临床及病理的关系。方法:回顾性分析2007年—2020年哈尔滨医科大学附属第二医院HSPN患儿的病例资料。结果:共纳入67例HSPN患儿,男34例,女33例,年龄6~18岁。其中,正常尿酸组40例,高尿酸血症组27例。与正常尿酸组相比,高尿酸血症组胱抑素C、三酰甘油、24 h尿蛋白定量、血肌酐和血浆纤维蛋白原水平较高,血清白蛋白水平较低,差异具有统计学意义。在不同的临床分型间,孤立性蛋白尿型、孤立性血尿型、急性肾炎型、血尿和蛋白尿型血尿酸水平均低于肾病综合征型。与正常尿酸组相比,高尿酸血症组病理分级、肾小球硬化/黏连比例及新月体形成比例较高,肾小管间质损害程度较重,差异具有统计学意义。结论:HSPN患儿中合并高尿酸血症者肾功能下降更明显,肾小球与肾小管损伤更严重,且肾病综合征型患儿血尿酸水平较高。血尿酸可能是评估HSPN患儿肾脏损伤程度及预后的重要指标之一。

Objective:To investigate the relationship between serum uric acid level and clinical and pathological features in children with Henoch Schonlein purpura nephritis(HSPN).Methods:The case data of HSPN children in the Second Affiliated Hospital of Harbin Medical University from 2007 to 2020 were analyzed retrospectively.Results:A total of 67 children with HSPN,34 males and 33 females,aged 6~18 years,were included.There were 40 cases in normal uric acid group and 27 cases in hyperuricemia group.Compared with the normal uric acid group,the levels of cystatin C,triglyceride,24 hour urinary protein,serum creatinine and plasma fibrinogen in hyperuricemia group were higher,and the serum albumin level was lower,with statistical significance.The levels of uric acid in isolated proteinuria,isolated hematuria,acute nephritis,hematuria and proteinuria were lower than those in nephrotic syndrome.Compared with normal uric acid group,hyperuricemia group had higher pathological grade,glomerulosclerosis/adhesion ratio,crescent formation ratio,and more severe tubulointerstitial damage.Conclusion:In HSPN children with hyperuricemia,renal function decreased more significantly,glomerular and renal tubular injury was more serious,and the level of serum uric acid in children with nephrotic syndrome was higher.Serum uric acid may be one of the important indicators to evaluate the degree of renal injury and prognosis in children with HSPN.