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。

Analysis of the correlation between clinical and pathological classification based on 371 children with purpura nephritis

ObjectiveTo analyze the clinical and renal pathology of children with Henoch-Schonlein purpura nephritis (HSPN). MethodsThe clinical and pathological data of children with HSPN treated in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine (our hospital) from January 1st, 2016 to December 31st, 2018,with biopsy pathology report and age at diagnosis ≤18 years, was retrospectively analyzed. ResultsA total of 371 HSPN children were included. Among them, 85.4% had abnormal urine test within one month after skin purpura, and skin purpura with digestive and joint symptoms accounted for 37.4%, with joint and muscle symptoms for 21.6%, and with digestive symptoms for 20.2%. Hematuria plus proteinuria accounted for 78.4%, nephrotic syndrome (NS) for 15.1%, and simple proteinuria and simple hematuria for 3.2%. Compared with hematuria plus proteinuria (3.8%, 11/291), NS (12.5%, 7/56) had a higher proportion of gross hematuria, χ2 =28.4, P < 0.01. The proportion of proteinuria in patients with gastrointestinal symptoms (45.8%, 98/214) was higher than those without gastrointestinal symptoms (40.1%, 63/157), χ2= 15.6, P < 0.001. Optical microscope grading with level Ⅲ was the most (74.9%), and type Ⅲa and Ⅲb all accounted for 46.6% and 28.3%, followed by type Ⅱ (21.3%). Clinical classification and optical microscopy classification (r=0.264, P<0.001) or renal tubular pathological grade（r=0.246，P＜0.001）, optical microscopy classification and renal tubular pathological grade (r=0.366, P＜0.001), proportion of crescent and 24 h urine protein (F=3.980, P=0.001) were related.There is certain correlation between Clinical features and pathological features, gastrointestinal symptoms and massive proteinuria, NS and gross hematuria, renal tubular lesions and pathological type, crescent proportion and 24 h urine protein level. ConclusionHematuria and proteinuria is the most common clinical type in children with HSPN, while Grade Ⅱ and Ⅲ are the most common pathological types.