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。

Clinical and pathological analysis of Henoch-Schonlein purpura nephritis in 279 children

Objective To study the feature of clinical and pathological type of Henoch-Sch6nlein purpura nephritis （HSPN） in children. Methods Clinical and pathological data of HSPN in 279 children were collected and retrospectively analyzed. Results Clinical manifestation of HSPN in 279 children with haematuria and proteinuria （ 107 cases ,38.4% ） was the most common type, followed by nephritic syndrome type （69 cases,24.7% ）,isolated proteinuria type （40 cases,14. 3% ）,isolated hematuria type （29 cases, 10. 4% ）, acute glomerulonephritis type （21 cases ,9. 3% ）, rapidly progressive glomerulonephritis type （8 cases ,2. 9% ）, chronic glomerulonephritis type （5 cases, 1.8 % ）. According to the International Study of Kidney Disease in Children,the majority renal pathological type of HSPN were grade Ⅱ（ 133 cases,47.7% ） and grade Ⅲ（ 109 cases,39. 1% ）. The pathological changes of hematuria and proteinuria type were mainly grade Ⅱ （61 cases,57. 0% ） and grade Ⅲ （35 cases,32.7% ） ,and the pathological change of nephritic syndrome type was grade Ⅲ （41 cases,59.4% ）. All of renal pathological changes,38.7% （108/279） had codeposition of immunoglobulins A and M ,30. 8% （ 86/279 ） had co-deposition of immunoglobulins A, G and M. The pathological change of nephritic syndrome type was more serious （X^2 = 35. 989, P 〈 0. 05 ）. Immune complex deposition was not correlated with renal pathologic classification （ P 〉 0. 05 ）. Conclusion The HSPN patients mainly show the type of hematuria and proteinuria and the type of nephritic syndrome. The majority renal pathological type of HSPN are grade Ⅱ and grade Ⅲ. In children with HSPN, the severity of the clinic symptoms is not completely consistent with the pathological changes. The pathological changes of nephritic syndrome type are more serious. To improve theprognosis of HSPN, we should make the treatment planning according to the clinical types and pathologic classification.