儿童紫癜性肾炎55例临床与病理分析

目的 探讨儿童紫癜性肾炎(Henoch-Sch(o)nlein purpura nephritis,HSPN)的临床和病理特点及其相关性,以指导治疗,改善预后.方法 收集2000年1月至2008年10月收治的55例紫癜性肾炎患儿的临床及病理资料,并且根据不同的条件分组进行网顾性分析.结果 临床分型中以血尿和蛋白尿最多,为22例(40.0%);肾病综合征型次之,16例(29.1%);单纯性蛋白尿或单纯性血尿型、急性肾炎型和急进性肾炎型占少数,分别为6例(10.9%)、4例(7.3%)和1例(1.8%).伴有消化道症状的紫癜性肾炎患儿,临床上较无消化道症状的患儿易有肾病水平蛋白尿(P<0.05).伴肉眼血尿患儿比镜下血尿者易出现肾病综合征(P<0.05).根据ISKDC标准,HSPN病理分级以Ⅱ级和Ⅲ级最多,分别为27例(49.1%)和16例(29.1%).免疫荧光检查显示IgA+IgG+IgM型为32例(58.2%),伴C3沉积41例(74.6%),病理分级主要在Ⅲ级以上.免疫沉积类型、C3沉积与病理分级有相关性(P<0.05).临床表现为单纯性血尿型或单纯性蛋白尿型的HSPN病理损害较轻,7例(58.3%)为Ⅱ级;血尿和蛋白尿型的病理分级以Ⅱ级和Ⅲ级多见,分别为12例(54.5%)和5例(22.7%);肾病综合征型的病理分级多见Ⅲ级以上,为10例(62.5%).结论 儿童紫癜性肾炎临床以血尿和蛋白尿型及肾病综合征型为主,病理分级以Ⅱ级和Ⅲ级最常见,免疫沉积物类型与C3沉积和病理分级有相关性.HSPN临床症状和病理损伤程度基本一致;消化道受累程度越重,出现蛋白尿的比例越高;肉眼血尿与肾脏损害的严重程度有关.     

儿童紫癜性肾炎临床分型 病理分级及预后相关性分析

目的探讨儿童紫癜性肾炎(HSPN)临床、病理与预后关系。方法研究对象为2008年5月至2013年4月收住于中国医科大学附属第一医院HSPN患儿40例,对其临床、病理及预后等资料进行统计学分析。结果 40例病理分级中I级14例(35.0%)、Ⅱ级13例(32.5%)、Ⅲa级6例(15.0%)、Ⅲb级3例(7.5%)、Ⅴ级1例(2.5%)、Ⅵ级3例(7.5%)。其中临床分型血尿和蛋白尿型最多,为25例(62.5%),临床分型越重,病理分级亦越重(P0.05)。皮疹出现次数与病理分级有相关性(χ2=5.1673,P0.05)。单纯Ig A沉积型22例(55.0%)、Ig A+Ig G型8例(20.0%)、Ig A+Ig M型5例(12.50%),Ig A+Ig G+Ig M型5例(12.50%)。HSPN肾小管间质病变(+)级32例,(++)级4例,(+++)级3例,(++++)级1例,肾小管间质病变与病理分级显著相关(r=0.50119,P0.05)。随访临床治愈30例(75.0%)、轻微尿异常8例(20.0%)、活动性肾脏病2例(5.0%),无肾功能不全患儿。免疫复合物沉积类型与病理分级分布差异无统计学意义(χ2=0.8225,P0.05)。HSPN患儿病理分级、肾小管间质病变程度和预后均为正相关(r=0.55826、0.56697,P0.05)。结论儿童HSPN皮疹反复发作多次,应警惕肾脏损伤。病理分级、小管-间质损害程度与预后正相关,尽早肾活检对了解肾脏病变情况十分必要。     

儿童紫癜性肾炎200例临床与病理分析

目的 探讨紫癜性肾炎(HSPN)患儿的临床表现与肾脏病理类型及转归的关系.方法 对200例HSPN患儿行经皮肾穿刺活检,同时测定免疫相关指标.根据不同的临床病理类型给予不同治疗方案,并对临床表现、实验室检查和组织学检查资料进行回顾性分析.结果 临床分型以血尿、蛋白尿型103例(51.5%)最多,肾病综合征型40例(20%)次之,急性肾炎型24例(12%)、单纯性血尿型或蛋白尿型20例(10%),急进性肾炎型8例(4%),慢性肾炎型5例(2.5%);肾脏病理分级以Ⅱ、Ⅲ级最多.有7例临床分型轻而病理分级为Ⅲ、Ⅳ级,有6例临床分型重,而病理分级为Ⅰ、Ⅱ级;免疫病理分型以 IgA + IgM沉积型最多(36%),其次为IgA + IgG + IgM沉积型(33%).随访0.5 ～ 5年,平均2.8年.结论 儿童HSPN临床症状的严重程度与病理损伤的程度不完全一致,病理分级与临床分型存在不平行性;病理级别Ⅲ级以下的治疗效果明显好于Ⅲ级以上,随着HSPN病理分级增高,临床治疗困难增加;皮质激素和免疫抑制剂环磷酰胺疗效肯定;经0.5 ～ 5年随访总体预后良好,有少部分患儿进入终末期肾病,尽快尽早治疗尤为重要.     

儿童紫癜性肾炎临床与病理相关性分析

目的：通过对95例紫癜性肾炎（HSPN）患儿临床表现及肾脏病理分析,阐明其临床及病理之间的联系。方法：对HSPN患儿进行临床分型及病理分级,对其进行综合分析。结果：①临床分型以肾病综合征型(27.4%)、蛋白尿＋血尿型(24.2%)多见,病理分级以Ⅲb(42.1%)最多见;②尿检正常者可见肾脏病理改变。尿检正常型、孤立性血尿或蛋白尿型以及血尿和蛋白尿型病理改变差异无显著性(P>0.05);③孤立性血尿或蛋白尿型以及血尿和蛋白尿型病例,病程越长病理分级也越重(P＜0.05);④免疫复合物沉积以IgA+IgG+IgM（58%)同时存在比例最高;病理分级越重,病程越短,IgA+IgG+IgM比例越高。结论：HSPN患儿临床表现为肾病综合征和肾炎型者病理改变相对较重,临床症状与病理不一定平行,尿检正常者病理改变也很明显,病程越长,病理改变呈加重趋势。免疫复合物沉积为IgA+IgG+IgM的病理改变相对较重。［中国当代儿科杂志,2007,9（2）：129-132］     

过敏性紫癜肾炎的临床与病理分析

目的　回顾性分析经肾活检证实为紫癜肾炎 (HSPN) 2 0例患儿临床、病理特点。方法　根据不同肾小球或肾小管 间质病理分型将 2 0例过敏性紫癜性肾炎患儿分组 ,并比较、分析临床特点。结果　肾小球病理改变为Ⅱ、Ⅲ级 2型 ,病例在起病年龄、性别、临床分型、肾外症状等方面差异无显著性意义 ,但Ⅲ级组蛋白尿排出显著多于Ⅱ级组、肾小管 间质病变程度也显著重于Ⅱ级组 ,此外HSPN组尿微量蛋白、血浆IgA、C3 浓度等较正常对照组显著增高。结论　紫癜肾炎大部分患儿均同时存在肾小球及肾小管病变 ,两者基本病变相平行 ,与临床表现存在相关性     

蛋白尿表现的儿童紫癜性肾炎临床与病理分析

目的探讨临床以蛋白尿为表现的儿童紫癜性肾炎(HSPN)的肾脏病理和临床特点。方法回顾性分析180例临床以蛋白尿为表现的HSPN患儿的临床和病理资料,并根据24 h尿蛋白定量进行分组比较。结果临床分型中以中度蛋白尿型最多(57例,31.7%),其次是大量蛋白尿型(51例,28.3%)、轻度蛋白尿型(46例,25.6%)和微量蛋白尿型(26例,14.4%);根据国际儿童肾脏病研究协会(ISKDC)标准,病理分级以II级(92例,51.1%)和III级(73例,40.6%)最多。中度蛋白尿型的病理分级以II级(31例,54.4%)多见,大量蛋白尿型的病理分级以III级(33例,64.7%)多见。随着蛋白尿严重程度的增加,病理分级呈递增趋势,差异有统计学意义(χ2=39.54,P=0.002)。免疫病理分型以IgA+IgM沉积型多见(84例,46.7%),IgA+IgM+IgG沉积型次之(55例,30.6%)。免疫病理分型与病理分级及临床分型无相关性(P0.05)。结论以蛋白尿为表现的HSPN患儿临床表现为大量蛋白尿者病理改变相对较重,但临床症状与病理损伤程度不完全一致。     

儿童过敏性紫癜肾炎的临床及病理分析

目的探讨过敏性紫癜肾炎(HSPN)患儿临床与病理特点。方法选择2009年4月至2013年4月HSPN患儿89例,回顾性分析其临床及病理资料。结果多数HSPN发生于紫癜病程2个月内,89例患儿的临床分型以血尿和蛋白尿型(41.6%)、肾病综合征型(27.0%)、孤立性蛋白尿型(21.3%)多见,而三者的病理分级均以Ⅲ级多见,分别占67.6%、70.8%、73.7%。不同临床分型紫癜肾患儿病理分级分布的差异有统计学意义(H=26.88,P=0.000)。21例合并消化道出血与68例无消化道出血患儿的病理分级差异有统计学意义(Z=2.00,P=0.046),有消化道出血患儿的病理分级多为Ⅲ级和Ⅳ级,而无消化道出血患儿多为Ⅱ级和Ⅲ级。免疫复合物分型以Ig A+Ig M沉积最多(40.45%),不同免疫复合物分型的病理分级分布差异无统计学意义(P0.05)。结论 HSPN患儿临床分型与病理分级相关,病理分级以Ⅱ和Ⅲ级多见,合并消化道出血者病理分级较重。     

基于371例儿童紫癜性肾炎的临床与病理分型的相关性分析

目的探讨儿童紫癜性肾炎(HSPN)的临床和肾脏病理特点。方法回顾性分析2016年1月1日至2018年12月31日在河南中医药大学第一附属医院（我院）儿科住院、有肾活检病理报告、年龄＜18周岁的HSPN患儿的临床和病理资料。结果371例HSPN患儿进入本文分析,男223例、女148例,中位年龄10（2~18）岁。①85.4%患儿于皮肤紫癜后1个月内出现尿检异常。紫癜伴消化道和关节症状者占37.5%,紫癜伴关节、肌肉症状者占21.6%,紫癜伴消化道症状者占20.2%。②临床分型：血尿加蛋白尿型占78.4%,肾病综合征（NS）型占15.1%,单纯性蛋白尿型和单纯性血尿型各占3.2%。NS型（12.5%,7/56）较血尿加蛋白尿型（3.8%,11/291）中肉眼血尿比例较高（χ2=28.4,P＜0.01）。有消化道症状者（45.8%,98/214）较无消化道症状者大量蛋白尿的比例高（40.1%,63/157）（χ2=15.6,P＜0.001）。③光学显微镜分级以Ⅲ级最多（74.9%）,其中Ⅲa和Ⅲb型各占46.6%和28.3%,其次为Ⅱ型（21.3%）。免疫荧光分型以IgA型最多（83.3%）。④临床分型与光学显微镜分级（r=0.264,P＜0.001）和肾小管病理分级（r=0.246,P＜0.001）、光学显微镜分级与肾小管病理分级（r=0.366,P＜0.001）、新月体的比例与24 h尿蛋白量（F=3.980,P=0.001）均有相关性。结论儿童HSPN临床以血尿加蛋白尿型最常见,病理以Ⅱ级和Ⅲ级多见。临床与病理、消化道症状与大量蛋白尿、NS型和肉眼血尿、肾小管病变程度与病理分型、新月体含量与24 h尿蛋白水平等均有一定相关性。     

基于371例儿童紫癜性肾炎的临床与病理分型的相关性分析

目的探讨儿童紫癜性肾炎(HSPN)的临床和肾脏病理特点。方法回顾性分析2016年1月1日至2018年12月31日在河南中医药大学第一附属医院（我院）儿科住院、有肾活检病理报告、年龄＜18周岁的HSPN患儿的临床和病理资料。结果371例HSPN患儿进入本文分析，男223例、女148例，中位年龄10（2~18）岁。①85.4%患儿于皮肤紫癜后1个月内出现尿检异常。紫癜伴消化道和关节症状者占37.5%，紫癜伴关节、肌肉症状者占21.6%，紫癜伴消化道症状者占20.2%。②临床分型：血尿加蛋白尿型占78.4%，肾病综合征（NS）型占15.1%，单纯性蛋白尿型和单纯性血尿型各占3.2%。NS型（12.5%，7/56）较血尿加蛋白尿型（3.8%,11/291）中肉眼血尿比例较高（χ2=28.4，P＜0.01）。有消化道症状者（45.8%，98/214）较无消化道症状者大量蛋白尿的比例高（40.1%，63/157）（χ2=15.6，P＜0.001）。③光学显微镜分级以Ⅲ级最多（74.9%），其中Ⅲa和Ⅲb型各占46.6%和28.3%，其次为Ⅱ型（21.3%）。免疫荧光分型以IgA型最多（83.3%）。④临床分型与光学显微镜分级（r=0.264，P＜0.001）和肾小管病理分级（r=0.246，P＜0.001）、光学显微镜分级与肾小管病理分级（r=0.366，P＜0.001）、新月体的比例与24 h尿蛋白量（F=3.980，P=0.001）均有相关性。结论儿童HSPN临床以血尿加蛋白尿型最常见，病理以Ⅱ级和Ⅲ级多见。临床与病理、消化道症状与大量蛋白尿、NS型和肉眼血尿、肾小管病变程度与病理分型、新月体含量与24 h尿蛋白水平等均有一定相关性。     

儿童紫癜性肾炎的临床病理及预后

目的 探讨儿童紫癜性肾炎的临床、病理类型及其与预后的关系.方法 回顾性分析1999年6月一2006年6月住院的79例紫癜肾炎患儿的临床病理类型及预后的关系,其中72例随访1~6年.结果 临床表现为血尿和蛋白尿、单纯性血尿、肾病综合征者最多,急进性肾炎最少.肾脏病理表现为系膜增生、肾小球硬化、新月体形成,分级以Ⅱ、Ⅲ级最多,Ⅱ级占73.3%.临床痊愈占70.8%,少数预后不良.结论 紫癜性肾炎病理改变以Ⅱ、Ⅲ级为主;其预后与临床表现、病理分级密切相关.     

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??Objective??To investigate the correlation between different levels of proteinuria and renal pathological lesion in children with primary IgA nephropathy??in order to provide references for the treatment and condition assessment. Methods??A total of 32 IgAN patients with a renal biopsy from the Pediatric Department of the First Affiliated Hospital of China Medical University from August 2005 to July 2015 were chosen. According to the level of 24 h urinary protein??UP????the 32 cases were separated into 3 groups??mild group??UP??0.5 g??n??17????moderate group??0.5-2.0 g??n??9?? and severe group??UP??2 g??n??6??. Their clinical and pathological data were studied retrospectively. Results??The proportion of patients with mild??moderate and severe proteinuria were 53.1%?? 28.1% and 18.8% respectively. Proteinuria was positively correlated with glomerular integral and tubular interstitial integral??P??0.05??. The majority of pathological changes of IgAN were grade ??and grade ??each with 14 cases??43.8%??. With the increasing level of albuminuria??the degree of pathological damage increased??P??0.05??. Crescentic lesions were found in 13 cases??40.6%????and with the increasing degree of the proteinuria??the incidence of crescent lesions had an increasing tendency??P??0.05??. Conclusion??There is correlation between proteinuria and renal pathological changes in children with IgA nephropathy. The level of proteinuria can reflect the pathological damage of glomerular and renal tubule to a certain extent. Children with mild proteinuria??who have IgA nephropathy??also have the potential to progress to ESRD. They need to be treated actively to reduce urinary protein and delay the progression of the disease.     

279例儿童紫癜性肾炎临床与病理分析

目的了解儿童紫癜性肾炎的临床和病理特点。方法回顾性分析279例儿童紫癜性肾炎患儿的临床和病理资料。结果279例儿童紫癜性肾炎的临床分型以血尿和蛋白尿型最多（107例,38．4％）,其次是肾病综合征型（69例,24．7％）,孤立性蛋白尿型（40例,14．3％）,孤立性血尿型（29例,10．4％）,急性肾炎型（21例,9．3％）,急进性肾炎型（8例,2．9％）,慢性肾炎型（5例,1．8％）。根据国际儿童肾脏病研究中心标准,279例儿童紫癜性肾炎的病理分级以Ⅱ级和Ⅲ级最多,分别为133例（47．7％）和109例（39．1％）,血尿和蛋白尿型的病理分级以Ⅱ级（61例,57．0％）和Ⅲ级（35例,32．7％）多见,肾病综合征型的病理分级以Ⅲ级多见（41例,59．4％）。免疫病理分型以IgA＋IgM沉积型多见（108例,38．7％）,IgA＋IgM＋IgG沉积型次之（86例,30．8％）。肾病综合征型的病理改变相对较重（X^2=35．989,P〈0．05）,免疫病理分型与病理分级无相关性（P〉0．05）。结论儿童紫癜性肾炎临床以血尿和蛋白尿型及肾病综合征型为主,病理分级以Ⅱ级和Ⅲ级常见,但临床症状与病理损伤的程度不完全一致,肾病综合征型的病理改变相对较重。应根据临床类型和病理分级制定治疗计划,改善预后。     

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??Abstracts?? Objective To investigate the expression of RLX in blood and renal tissue of patients with HSP?? and its correlation with clinical indexes and pathological changes?? and explore its effect on the pathogenesis of HSP. Methods Collect 39 cases of Henoch-Schonlein purpura ??HSP?? from Department of Nephrology in Children’s Hospital of Jiangxi province from November 2011 to June 2012?? with complete follow-up data. According to the clinical urine manifestation?? 39 patients with HSP were divided into non-kidney damage group ??n=20?? and kidney damage group ??n=19??. All 39 patients were collected blood samples in the acute and convalescent phase. Nineteen patients from kidney damage group were divided into mild lesions ??n=5???? moderate lesions ??n=9??and severe lesions ??n=5???? according to the degree of pathological changes. RLX concentration was detected with enzyme-labeled immunosorbent assay ??ELISA?? method.RLX protein expression in renal tissue was detected with immunohistochemistry method. Results In the acute phase?? the serum level of RLX in HSP was significantly higher than normal control?? and its concentration was significantly higher in kidney damage group than in non-kidney damage group ??P??0.05??. Compared with acute phase?? the serum level of RLX in HSP in the convalescent phase was significantly lower?? and the level of decline was slower in kidney damage group than in non-kidney damage ??P??0.05??. Weak expression of RLX in renal tissue was found in normal control??while the expression of RLX in renal tissue significantly increased in HSPN ??P??0.05???? with the pathological changes of renal tissue aggravating. The expression of RLX in renal tissue in HSPN was significantly correlated with the serum concentration of RLX ??P??0.05?? and the total urine protein for 24 hours ??P??0.05??. Conclusion There is a modest up-regulation in serum and renal RLX protein expression in HSP?? and the severity of the disease is closely related with RLX expression?? which suggests that RLX may be involved in the pathogenesis of HSP/HSPN?? and it may be an important mechanism that upregulation of RLX may play a defensive role in delaying disease progression of HSP/HSPN.     

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??Abstract??Objective To investigate the clinical efficacy and safety of tacrolimus ??FK506?? therapy for children with steroid-dependent and steroid-resistant nephrotic syndrome ??NS??. Methods From Jun.2007 to Dec.2011 in Guangzhou Medical College Guangzhou First Municipal People's Hospital??42 children with primary nephrotic syndrome were enrolled??in which 32 cases were steroid-dependent NS ??SDNS?? and 10 cases were steroid-resistant NS ??the SRNS??. The indicators were tested before treatment and 12 weeks later??including ??1?? the 24h urinary protein excretion??blood urea nitrogen ??BUN????serum creatinine ??Scr????plasma albumin ??Alb????blood and urine ??2-microglobulin ????2-MG??????2?? lipid testing indicators??total cholesterol ??TC????triglyceride ??TG??????3??hypercoagulable state indicators??the prothrombin time ??PT????activated partial thromboplastin time ??APTT ????the plasma concentration of fibrinogen ??Fib?? and blood D-dimer ??D-dimer??. Results Tacrolimus combined with steroid therapy had significant effects.The clinical and biochemical indicators improved significantly after treatment ??P??0.05 or P??0.01????lipids and hypercoagulability-related indicators also improved significantly??proteinuria significantly reduced.Complete remission was achieved in 29 cases??partial remission in 10 cases??no remission in 4 cases.Eleven cases of simple type NS got complete remission??and 18 cases of nephritis type NS got complete remission??partial remission in 9 cases??no remission in 4 cases.Pathological type??5 cases of minimal change disease??complete remission????5 cases of focal segmental glomerulosclerosis??3 no remission??2 partial remission????six cases of mesangial proliferative glomerulonephritis??4 complete remission??2 partial remission??.Mild gastrointestinal reaction occurred in 4 cases and diarrhea in 2 cases.Conclusion The tacrolimus and steroid combination therapy for children with steroid-dependent and steroid-resistant NS can reduce proteinuria??reduce high cholesterol and improve the hypercoagulable state??the majority of children get complete remission??steroid-resistant nephrotic syndrome also has a significant improvement in the treatment.This combined treatment is safe and effective with fewer adverse reactions.     

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??Abstract:Objective To investigate the clinical characters??pathological characters??treatment and prognosis of primary IgM nephropathy in children for reference. Methods The data of 49 cases of children with primary IgM nephropathy were reviewed from Jun.2001 to Oct.2009 Department of Nephrology??in Shengjing Hospital Affiliated to China Medical University.The clinical presentation??pathological features ?? curative effects and prognosis were analyzed. Results ??1?? clinical types include asymptomatic proteinuria??1/49???? gross hematuria with proteinuria??1/49????primary nephrotic syndrome??47/49??. ??2??IgM was seen as granular deposition in the mesangium under light-immunofluorescence. 7 cases were ball wall thickening or adhesion layer??8 cases were focal tubular atrophy?? 1 case had cellular fibrous crescents??6 caess had focal segmental glomerulosclerosis. ??3??Other immunosuppressants together with follow-up observation was applied in that conventional treatment unsatisfactly.Among 44 cases of follow-up observation ??35 cases after complete remission had not yet relapsed. Conclusion Primary IgM nephropathy should be seen as an independent entity??the main clinical type is primary nephrotic syndrome??refractory nephritic disease is the most common?? moderate mesangial cell proliferation is more common histological type??new immunosuppressive agents are expected to gain the better results??long-term prognosis needs further follow-up study.     

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??Objective To analyze the clinical characteristics and prognosis of pneumonia complicated with acute respiratory distress syndrome??ARDS?? in pediatric hematological patients in order to improve the clinical treatment level. Methods The data of clinical symptoms??laboratory result??treatment??prognosis and risk factors of 35 hematological children with pneumonia and ARDS admitted between March 2012 and January 2015 in Department of Pediatrics??Sun Yat-sen Memorial Hospital??Sun Yat-sen University were retrospectively analyzed. Results The 35 hematological children with pneumonia and ARDS had high fever??71.4%????cough??85.7%????shortness of breath??88.6%????cyanosis??74.3%????three concave sign positive??74.3%?? and lung rale??65.7%??. The level of PaO2/FiO2 decreased??chest X-ray showed patchy or patchy infiltrates??and diffuse exudation and large consolidation in severe cases. A total of 29 strains of pathogens were isolated??including 22 strains of gram-negative bacteria. In 35 ARDS children??23 cases died??65.7%????and the main cause of death was MODS??in 12 cases??52.2%??. The death cause was related to no remission in primary disease??MODS??shock??severe chest infiltration and the use of mechanical ventilation??P??0.05????but not to the way of mechanical ventilation??P??0.05??. Logistic regression analysis showed that MODS and shock were the independent risk factors of death??P??0.05??. Conclusion The hematological children with pneumonia and ARDS should get more attention for its high mortality. It can be diagnosed early according to the clinical symptoms and signs??the blood gas analysis and chest X-ray. MODS and shock are the independent risk factors of death.     

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??Objective??To analyze the clinical characteristics??pathological features and treatment responses of 6 pediatric patients with C3 glomerulonephritis??C3GN????in order to improve the understanding and treatment of this disease for pediatricians. Methods??Analyze the clinical manifestations??pathological features??therapies??prognosis of patients who were diagnosed with C3 glomerulonephritis from September??2010 to June??2016 retrospectively. Results??Clinical characteristics and laboratory examination??2 patients’ first symptom was hematuria??4 patients’ first symptom was hematuria and proteinuria??3 patients presented as acute nephritic syndrome??one presented as nephrotic syndrome. All the patients showed that the level of serum complement C3 was reduced??while sernm complement C4 was normal. Pathological character??6 patients showed strong positive complement C3 deposition under immunofluorescence. Lightmicroscopy showed mesangial proliferative glomerulonephritis in 5 cases??1 case was diagnosed as endocapillary proliferative glomerulonephritisin??and 3 patients presented electrondense depositionin under electron microscope. Treatment and prognosis??after conventional treatment??2 patients who were with crescent were treated with glucocorticoid .After a follow-up from 6 months to 42 months ??the prognosis was pretty good. Conclusion??Children with C3GN are usually presented with hematuria and ??or??proteinuria??characterized by strong positive C3 deposition. Lightmicroscopy always shows mesangial proliferative glomerulonephritis. Electron microscope show electron dense deposition??and short-term prognosis is pretty good.     

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??Abstract??Objective??To review the clinical features?? pathogenesis?? diagnosis?? treatment and prognosis of the reported children with acquired hemophilia A??AHA???? and to enhance the understanding of them. Methods??Eighteen children with acquired hemophilia ??including 2 cases from our hospital and sixteen cases from MEDLINE search?? were retrospectively analyzed and compared with adults with AHA. Results??The average age of onset was 6.6 years ??ranging from 2 to 14 years??. The average course from initiation of clinical symptom to making definite diagnosis was 3.1 months ??ranging from 1 week to 2 years??. The underlying conditions included infection??7 cases??38.9%???? penicillin??3 cases??16.6%???? kidney diseases??3 cases??16.6%?? and autoimmune diseases??2 cases??11.1%???? and only 3 patients had no reason to detect. The majority presenting symptoms were skin ecchymoses??61.1%??11/18?? and muscle hematoma??55.6%??10/18??.Seven cases??38.9%?? and 8 cases??44.4%?? acquired complete remission ??CR?? by the treatment of underlying conditions and??or no??immunosuppressive agents within 6 weeks and 60 months respectively. The overall CR rate reached 83.3%?? only 2 patients died of severe bleeding. The severity of hemorrhage and the time to obtain CR had no correlation with the level of APTT?? F?? ?? C and the titer of F?? ?? Ab??P > 0.05??. Conclusion??The report of children AHA is rare. It usually has underlying conditions. It is helpful for early diagnosis to understand clinical features and diagnostic flow of children AHA. It has good prognosis by the proper treatment of underlying dieases and necessary immunosuppressive agents.     

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??Abstract??Objective??To study the clinical features of hand-foot-mouth disease ??HFMD?? caused by enterovirus 71 ??EV71?? infection. Methods Clinical data of hospitalized children with hand-foot-mouth disease caused by EV71 infection from May 2010 to August 2010 were analyzed retrospectively. The difference of clinical manifestation and results of auxiliary examination between intensive HFMD group and serious HFMD group were compared. Results??High fever and nontypical skin rash showed significant difference between intensive group and serious group??P = 0.002??P = 0.000??respectively???? 120 EV71-positived HFMD cases ??99.17%?? showed neurological impairments. The major neurological features included fatigue ??84.30%????frequent vomiting ??65.30%????limb tremble ??60.33%?? and sleep disorders ??53.72%??. The rate of abnormal knee reflex was 52.07% in physical examination. The incidence of vomiting??P = 0.001????unconsciousness ??P = 0.000????abnormal muscular tension??P = 0.000????abnormal heart rate ??P = 0.000????dysarteriotony ??P = 0.000????capillary refill time being more than 3 seconds ??CRT > 3 s?? ??P = 0.000????tachypnea or dyspnea ??P = 0.000?? and pulmonary exudative lesion in chest X-ray ??P = 0.000?? was morefrequent in serious group compared with intensive group??There were 51 cases ??42.15% ?? with a peripheral blood WBC count of more than 12 × 109/L or less than 4×109/L??52 cases ??42.98% ?? with blood glucose level of more than 6 mmol/L and cardiac troponin I elevated in 22 cases ??18.18%??. The above three indexes were significantly different between two groups ??P < 0.000??respectively??. Conclusion??HFMD caused by EV71 infection often shows neurological impairments. High fever??nontypical skin rash??frequent vomiting??unconsciousness??abnormal muscular tension??abnormal heart rate??dysarteriotony??CRT > 3s??tachypnea or dyspnea??and pulmonary exudative lesion are risk factors of serious HFMD. Early identification and correct treatment are the key to the rescue of serious HFMD.