婴幼儿肾小球疾病的病理类型分布与临床诊断

Analysis of clinical and pathological data in 111 infants with kidney disease

目的 探讨婴幼儿肾小球疾病的病理类型分布及其与临床诊断的联系。方法 回顾性分析 111例 3岁以下婴幼儿肾活检资料 ,按照 2 0 0 1年全国儿科学会肾脏病学组制定的方案 ,结合临床资料、实验室检查结果确定诊断。结果 111例中 ,男孩 81例 ,女孩 30例 ,平均年龄 2 .7岁 (3个月～ 3岁 ) ,男女之比为 2 .7∶1,其中 1岁以下 4例 (男 3例 ,女 1例 ,男女之比 3∶1) ,1～ 2岁 4 3例 (男 31例 ,女 12例 ,男女之比 2 .6∶1) ,2岁以上 6 4例 (男 4 7例 ,女 17例 ,男女比 2 .8∶1) ;病理类型包括 :原发性肾小球疾病 10 3例 (92 .8% ) ,继发性肾小球疾病 3例 (2 .7% ) ,遗传性肾小球疾病 5例 (4 .5 % )。其中微小病变 30例 (2 7.0 % ) ,系膜增生 5 3例 (4 7.7% ) ,IgA肾病 14例 (12 .6 % ) ,膜增殖 5例 (4 .5 % ) ,膜性肾病 2例 (1.8% ) ,毛细血管内增生 1例 (0 .9% ) ,局灶节段性硬化 1例 (0 .9% ) ,婴儿髓质囊性病 1例 (0 .9% ) ,Alport综合征 1例 (0 9% ) ,弥漫性系膜硬化 3例 (2 .7% )。结论 结果表明国内婴幼儿阶段的肾小球疾病仍以原发性为主 ,病理分类依次为系膜增生、微小病变等 ;婴幼儿肾活检是安全可靠的检查 ,通过肾活检可以明确病理类型 ,为临床制订治疗方案以及预测治疗效果和预后提供了可靠的依?

Objective To investigate the significance of renal biopsy in clinical diagnosis and therapy in infants suffered from various kidney diseases. Methods The diagnosis was established according to criteria made by national study group of kidney diseases in children, combining with clinical material and lab examination shows. Results There were 111 kidney disease infants. Among them, 103 were primary renal diseases(92.8%), 3 secondary renal diseases(2.7%), and 5 congenital renal diseases(4.5%). Their histological shows were as follows: 30 with minimal change disease(27.0%), 53 with mesangial proliferative glomerulonephritis(47 7%), 14 with IgA nephropathy(12.6%), 5 with membranous proliferative glomerulonephritis(4.5%), 2 with membranous nephropathy(1 8%), 1 with endocapillary proliferative glomerulonephritis(0 9%), 1 focal segmental glomerulosclerosis(0 9%), 1 infantile medullary cystic disease(0 9%), 1 with Alport's syndrome(0 9%), and 3 with diffuse mesangial sclerosis(2 7%). Conclusion Above data suggest that the most majority is primary renal disease in domestic infants with glomerulonephritis, whose histological types are mesangial proliferative glomerulonephritis, and minimal change disease in turn. The percutaneous renal biopsy in infants is one type of relative safe and reliable diagnostic technique. It can interpret the histoogical changes, correct the clinical diagnostic error, and provide reliable evidence for treatment and for judging prognosis.