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目的通过对49例经肾活检证实为紫癜性肾炎(HSPN)患儿临床、病理特点及免疫指标的分析,探讨临床表现及病理类型与免疫指标的关系。方法对HSPN患儿进行临床病程及病理分级。采用配对方法对病程、年龄相同肾活检患儿与过敏性紫癜尿检正常的患儿免疫球蛋白指标进行比较;对肾活检结果不同患儿免疫球蛋白指标进行比较。结果肾小球病理改变为Ⅱ、Ⅲ、Ⅳ型,病理分级以Ⅱb所占比例最大(53.06%,26/49),Ⅲb级次之(28.57%,14/49);临床表现以血尿伴蛋白尿者居多,共37例(75.51%,37/49),其中达肾病水平蛋白尿19例(38.77%,19/49);肾脏病理结果中,以弥漫性系膜增生为主(93.88%,46/49),在血尿伴肾病水平蛋白尿中,63.12%伴有新月体形成和肾小球局灶节段硬化,在肾小管及间质损伤的6例中,临床上均有血尿;不同肾活检结果之间免疫球蛋白比较无差异;肾活检患儿与过敏性紫癜尿检正常的患儿免疫球蛋白指标比较仅病程<1个月的肾活检组血清免疫球蛋白低于IgG尿检正常对照组(P<0.0345)。结论儿童HSPN肾脏损害的严重程度与免疫球蛋白改变关系不大。
Objective To investigate the clinical and pathological features and immunological parameters in 49 children with HSPN confirmed by renal biopsy, and to explore the relationship between clinical manifestations and pathological types and immune indexes. Methods HSPN children with clinical course and pathological grade. The paired methods were used to compare the immunoglobulin index of children with normal renal biopsy and normal urine purpura in the course of disease and age, and the immunoglobulin indexes of children with different renal biopsy results were compared. Results The pathological changes of glomerulus were type Ⅱ, Ⅲ and Ⅳ. The pathological grade Ⅱb accounted for the largest proportion (53.06%, 26/49) and Ⅲb (28.57%, 14/49). The clinical manifestations of hematuria with protein There were 37 cases (75.51%, 37/49) with urinary tract, of which 19 cases (38.77%, 19/49) had nephropathy level proteinuria. Among the renal pathological findings, diffuse mesangial hyperplasia (93.88% 46/49), hematuria with nephrotic proteinuria, 63.12% with crescent formation and focal segmental sclerosis in renal tubular and interstitial injury in 6 cases, clinically hematuria; Immune globulin between different renal biopsy results was no difference; children with renal biopsy and normal urine protein in children with normal urinary protein index only disease <1 month renal biopsy group serum immunoglobulin is lower than the normal urinalysis of IgG Control group (P <0.0345). Conclusion The severity of kidney damage in children with HSPN has little to do with the change of immunoglobulin.