单中心66例儿童IgA肾病肾脏病理Lee氏分级与临床特征的相关性分析

目的　旨在探讨儿童IgA肾病（IgA nephropathy，IgAN）肾脏病理Lee氏分级与其临床特征的可能关系。方法　回顾性分析了广州市妇女儿童医疗中心肾内科2017年7月至2020年12月收治的66例IgAN患儿的临床及肾脏病理Lee氏分级数据。统计学方法采用单因素方差分析、Kruskal-Wallis H检验、Spearman秩相关分析。结果　本研究纳入的66例IgAN患儿中，男44例（66.7%），女22例（33.3%），男女比例2∶1，年龄（7.7±2.6）岁。66例IgAN患儿临床表现以血尿合并蛋白尿为主（49例），其次为孤立性血尿（16例），孤立性蛋白尿（1例）；10例（15.2%）IgAN患儿有肾脏病家族史。肾脏病理以Lee氏Ⅲ级最常见，共39例（59.1%），其次为Ⅱ级17例（25.7%），Ⅳ级5例（7.6%），Ⅰ级3例（4.5%），Ⅴ级2例（3.0%）。不同Lee氏分级的患儿24 h尿蛋白定量（24 h-UP）、尿蛋白比尿肌酐、血清胱抑素C、肾小球滤过率（GFR）差异均有统计学意义（均P<0.05）。Spearman相关性分析显示，Lee氏分级与患儿的24 h-UP、尿蛋白比尿肌酐、血肌酐、尿素氮（BUN）、血清胱抑素C值间呈正相关（均P<0.05），与GFR呈负相关（P<0.05）。结论　血尿合并蛋白尿是本次研究儿童IgAN最普遍的临床特征，Lee氏分级以Ⅲ级为主，患儿蛋白尿水平、肾功能指标与Lee氏分级间存在显著相关性。

Correlation analysis between pathological Lee's grade and clinical characteristics in 66 children with IgA nephropathy in a single center

Objective　To investigate the possible relationships between pathological Lee's grade and clinical features of IgA nephropathy (IgAN) in children. Methods　The clinical and pathological Lee's grade data of 66 children with IgAN who were enrolled in the Department of Nephrology, Guangzhou Women and Children's Medical Center from July 2017 to December 2020 were retrospectively analyzed. One-way analysis of variance, Kruskal-Wallis H test, and Spearman rank correlation analysis were used for statistical analysis. Results　Among the 66 IgAN children in this study, there were 44 males (66.7%) and 22 females (33.3%), the ratio of male to female was 2:1, and the age was (7.7±2.6) years old. The clinical manifestations of the 66 IgAN children were dominated by hematuria combined with proteinuria (49 cases), followed by isolated hematuria (16 cases), and isolated proteinuria (1 case); 10 cases of IgAN children (15.2%) had a family history of kidney disease. Lee's grade III was the most common pathological type, counting for 59.1% (39 cases), followed by 25.7% (17 cases) of grade II, 7.6% (5 cases) of grade IV, 4.5% (3 cases) of grade I, and 3.0% (2 cases) of grade V. There were statistically significant differences in the 24 h urinary protein quantification (24 h-UP), ratio of urinary protein to urinary creatinine, serum cystatin C, and glomerular filtration rate (GFR) among children with different Lee's grades (all P<0.05). Spearman correlation analysis showed that Lee's grade was positively correlated with 24 h-UP, ratio of urinary protein to urinary creatinine, serum creatinine, urea nitrogen (BUN), and serum cystatin C (all P<0.05), and negatively correlated with GFR (P<0.05). Conclusions　Hematuria combined with proteinuria is the most common clinical manifestation of IgAN children in our study. The histological type is dominated by Lee's grade III. There are statistically significant correlations between proteinuria level, renal function indexes, and Lee's grade.