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目的通过对高原地区和平原地区肾小球疾病患儿进行肾脏活体组织穿刺术,探讨高原地区与平原地区肾脏疾病患儿病理类型分布是否存在区别。方法采用随机对照研究方案,将高原地区22例肾病患儿和平原地区22例肾病患儿进行肾活体组织穿刺术,分析高原地区和平原地区儿童肾病病理类型分布特点。其病理分型标准参照WHO 1982年的分类及改良的1995年肾小球病病理学分类标准。结果 1.高原地区肾小球疾病患儿与平原地区肾小球疾病患儿病理类型分布上有区别,高原地区以继发性肾小球疾病为多发,占所有肾活检病例的57.7%;而平原地区以原发性肾小球疾病为多见,占所有肾活检病例的85.0%。2组病理类型比较差异有统计学意义(P<0.001)。2.高原地区9例原发性肾小球疾病患者中,系膜增生性肾小球肾炎和IgA肾病各2例,各占9.5%;微小病变型肾病、局灶-节段性病变、毛细血管内增生性肾小球肾炎、系膜毛细血管性肾小球肾炎、新月体性肾小球肾炎各1例,各占4.7%;本组病理类型中无硬化性肾小球肾炎。高原地区继发性肾小球疾病病理类型中,以紫癜性肾炎为多见,其次为乙型肝炎病毒相关性肾炎,狼疮性肾炎。结论高原地区与平原地区肾病患儿病理类型分布存在区别;高原地区继发性肾小球疾病患病率高于平原地区继发性肾小球疾病患病率。
OBJECTIVE: To investigate whether there is a difference in the distribution of pathological types in children with kidney disease in plateau area and plains area through the renal biopsy of children with glomerular disease in plateau area and plains area. Methods 22 patients with nephropathy in the plateau and 22 patients with nephropathy in the plain were enrolled in this study. The pathological types of nephropathy in the plateau and plain areas were analyzed. The pathological classification of the standard reference to the classification of WHO in 1982 and improved glomerular pathology in 1995 classification criteria. Results 1. There was a difference in the distribution of pathological types between children with glomerular disease and plain glomerular disease in plateau area. Secondary glomerular disease was frequent in plateau area, accounting for 57.7% of all cases of renal biopsy; Plain areas with primary glomerular disease is more common, accounting for 85.0% of all cases of renal biopsy. There were significant differences in pathological types between the two groups (P <0.001). In 9 patients with primary glomerular disease in the plateau, mesangial proliferative glomerulonephritis and IgA nephropathy in 2 cases, each accounting for 9.5%; minimal change nephropathy, focal segmental lesions, capillary 1 cases of vascular proliferative glomerulonephritis, mesangial capillary glomerulonephritis, crescentic glomerulonephritis in 1 case, each 4.7%; this group of pathological types of non-sclerosing glomerulonephritis. Plateau secondary glomerular disease pathological types, purpura nephritis is more common, followed by hepatitis B virus-associated nephritis, lupus nephritis. Conclusion The distribution of pathological types of children with nephropathy in plateau and plain areas are different. The prevalence of secondary glomerular disease in plateau is higher than that in plain areas.