激素耐药型和激素依赖型肾病患儿肾脏病理计量分析

目的 探讨病理计量分析评价激素耐药型（SR）和激素依赖型（SD）肾病综合征患儿的肾脏病理损害及其临床应用意义。方法 采用自行研制的评分法，对73例SR型和SD型肾病患儿的肾脏病理从病理类型、肾小球病变、小管间质病变、肾脏总的病理损害4个方面计量分析，并以血尿素氮为应变量，临床表现和肾脏病理计分为自变量进行逐步回归分析。结果 （1）病理类型评分结果：微小病变、局灶节段肾小球硬化、膜性肾病、系膜毛细血管性肾小球肾炎和系膜增生性肾小球肾炎五组间的年龄、病程、复发次数、血尿素氮、胆固醇、白蛋白、尿蛋白定量、肾脏总的病理损害的差异均无显著意义，而五组患儿的肾小球病变计分分别为1，5，5，6，5，微小病变组与其他各组比较差异有显著意义（H＝19．278，P＜0．01）。（2）73例患儿肾小球病变计分结果：正常2例（3％），轻度53例（73％），中度17例（23％），重度1例（1％）。且正常、轻度、中度三组间血尿素氮、小管间质病变的差异有显著意义（H＝8．40，P，0．01；H＝11．56，P＜0．05）。（3）肾小管间质病变计分结果：轻度23例（34％），中度37例（18％），且轻、中、重三组间病程、复发次数、血尿素氮、肾小球病变计分的差异均有显著意义。（H值分别为25．016，38．775，14．944，10．625，P值均＜0．01）。（4）肾脏损害的总分结果：轻度33例（45％），中度34例（7％），重度6例（8％），轻、中、重三组间病程、复发次数、血尿素氮的差异有显著意义（H值分别为19．42，14．335，18．923，P值均＜0．01）。（5）以血尿素氮为应变量行逐步回归分析，小管间质及肾小球损害对血尿素氮均有显著影响，小管间质病变的回归系数为0．862（P＜0．01）；肾小球病变的回归系数为0．212（P＜0．05）。结论 采用评分法对肾脏病理进行主分评价其病变程度，具有临床实用性，尤其对小管间质病变的计分评价对判断肾功能受损更有价值。

Quantitative analysis of renal pathology in children with steroid-resistant and steroid-dependent nephrotic syndrome

Objective To evaluate the significance in clinical application of renal pathologic quantity analysis in children with steroid resistant and steroid dependent nephrotic syndrome.Methods Seventy three cases (including 45 boys and 17girls with a median age of 9 years, and an average disease course of 18.1 months)with steroid resistant or steroid dependent nephrotic syndrome were involved in the study. The renal histopathological lesion was shown by the counting score designed by the authors, and evaluated according to the pathological type, glomerular lesions, tubulointerstitial lesions and the general lesions of the kidney. The correlations between the renal histopathological lesion and the onset age, the disease course, the recruitment frequency, the blood urea nitrogen, blood cholesterol, blood albumin, and 24 h urinary protein were studied. The blood urea nitrogen acted as the response variable, clinical manifestations and the renal pathology counting scores acted as the independent variable. The stepwise regression analysis was performed. Results (1) There were no significant differences among the onset age, disease course, recruitment frequency, blood urea nitrogen, blood cholesterol, blood albumin, 24h urinary protein in the minimal change disease (MCD) group, focal segmental glomerulosclerosis group, membranous nephropathy group, mesangiocapillary glomerulonephritis group and mesangial proliferative glomerulonephritis group. The renal counting scores of the five groups were 1, 5, 5, 6 and 5, respectively, and were significantly different between MCD group and the other groups ( H =19.278, P <0.01). (2)The renal counting scores in 73 patients were normal in 2 cases (3%), showed mild lesions in 53 cases (73%), moderate lesions in 17 cases (23%), and severe lesion in 1 case (1%). The difference between the blood urea nitrogen and the counting score of the tubulointerstitial lesions was significant ( H , 8.40 and 11.56; P <0.01, P <0.05, respectively) among the normal group, mild lesion group and the moderate lesion group. (3)The counting scores of the tubulointerstitial lesions in 73 cases showed mild lesions in 23 cases (34%), moderate lesions in 37 cases (51%), and severe lesions in 13 cases (18%) . The differences in the disease courses, recruitment frequency, blood urea nitrogen and the counting scores of the glomerular lesion were significant ( H =25.016, 38.775, 14 944 and 10.625, respectively; P <0.01) among the mild lesion group, moderate lesion group and severe lesion group. (4)The total counting scores of the renal lesions indicated mild in 33 cases (45%), moderate in 34 cases (47%) , and severe lesions in 6 cases (8%). The differences among the disease course, recruitment frequency and blood urea nitrogen were significant ( H =19.42, 14.335 and 18.923, respectively; P <0.01) among three groups. (5)The stepwise regression analysis showed that the lesions of tubulointerstitial and glomerulus significant influence on the blood urea nitrogen. The regression coefficient of the tubulointerstitial lesions was 0.862 ( P <0.01), the regression coefficient of the glomerular lesions was 0.212 ( P <0.05). Conclusion The counting score method was practical in evaluating the renal histopathological lesions. Especially, the counting score of tubulointerstitial lesions was more significant in estimating the impairment of the renal function.