儿童紫癜性肾炎患者临床分型、病理特征和病原菌感染的相关性临床分析

目的:探讨儿童紫癜性肾炎患者临床分型、病理特征和病原菌感染的相关性.方法:选择我院2011年1月~2016年1月住院紫癜性肾炎患儿80例,参照中华医学会儿科学分会的相关分型和病理分级标准对患者进行分级和分型.分析紫癜性肾炎患儿的临床分型、免疫复合物沉积、病原菌感染和病理分级的关系.结果:(1)一共80例儿童紫癜性肾炎患者,肾脏病理分级情况:Ⅰ级病例5例,Ⅱ级病例34例,Ⅲ级病例40例,Ⅳ级病例1例.(2)单纯性血尿或尿蛋白以Ⅱ级和Ⅲ级病理分级为主,Ⅱ级占比40%(8/20),Ⅲ级占比45%(9/20);血尿和尿蛋白合并以Ⅱ级和Ⅲ级病理分级为主,Ⅱ级占比60.53(23/38),Ⅲ级占比31.58%(12/38);肾病综合征以Ⅲ级病理分级为主,占比83.33(15/18).临床分型的严重程度和病理分级呈显著正相关关系,症状越明显,病理级别越高.(3)单纯IgA以Ⅱ级和Ⅲ级病理分级为主,Ⅱ级占比46.15%(6/13),Ⅲ级占比30.77%(4/13);IgA+IgM以Ⅱ级和Ⅲ级病理分级为主,Ⅱ级占比36.17%(17/47),Ⅲ级占比53.19%(25/47);IgA+IgG+IgM以Ⅱ级病理分级为主,占比53.33%(8/15).免疫复合物沉积的严重程度和病理分级无显著关系;补体C3沉积和病理分级呈显著正相关关系,补体C3沉积越严重,病理级别越高.(4)I型以Ⅱ级病理分级为主,占比51.43%(18/35);Ⅱ型以Ⅲ级病理分级为主,占比55.56%(25/45).幽门螺杆菌感染分型的严重程度和病理分级呈显著正相关关系,幽门螺杆菌感染分型越明显,病理级别越高.结论:儿童紫癜性肾炎患者临床分型、病理特征和病原菌感染密切相关,可以通过临床分型、病原菌感染、免疫复合物等病理情况对儿童紫癜性肾炎的病理损害进行评级,建议对于儿童紫癜性肾炎患儿应当尽早进行肾脏活检术,以确定病理分级,从而为选择合适的治疗方案提供有力的参考依据.

Clinical analysis of clinical classification,pathological features and pathogenic bacteria infection in children with purpura nephritis Pathogen infection

Objective To investigate the relationship between clinical classification, pathological features and pathogenic bacteria infection in children with purpura nephritis.Methods 80 cases of hospitalized children with purpura nephritis in our hospital from January 2011 to January 2016 were selected, and the patients were divided into cases according to the relevant classification and grading criteria of the Chinese medical science branch. To analyze the relationship between clinical classifi-cation, immune complex deposition, pathogenic bacteria infection and pathological grading in children with purpura nephritis. Results (1) a total of 80 cases of children with purpura nephritis, kidney pathology grade: Ⅰ grade5 cases, Ⅱ grade34 cases, Ⅲ grade40 cases, Ⅳ grade1 cases. (2) simple hematuria or proteinuria in Ⅱ grade and Ⅲ grade pathological grade, grade Ⅱ ac-counted for40% (8/20), grade Ⅲ accounted for 45% (9/20); hematuria and urinary protein combined with Ⅱ and Ⅲ pathological grade, grade Ⅱ accounted for60.53(23/38), accounting for Ⅲ 31.58% (12/38); kidney disease syndrome with Ⅲ pathologi-cal grade, accounting for83.33(15/18). The severity of clini-cal classification and pathological grading showed significant positive correlation, the more obvious symptoms, the higher the level of pathology. (3) IgA only with Ⅱ grade and Ⅲ grade pathological grade, grade Ⅱ accounted for 46.15% (6/13), grade Ⅲ accounted for 30.77% (4/13); IgA+IgM Ⅱ and Ⅲ Ⅱ level pathological grade, accounting for 36.17% (17/47), grade Ⅲ accounted for 53.19% (25/47); IgA+IgG+IgM grade Ⅱ pathological grade, accounting for 53.33% (8/15). There was no significant correlation between the severity of immune complex deposition and pathological grading. The C3 depo-sition and pathological grading showed significant positive correlation, the more serious the C3 deposition, the higher the pathological grade. (4) Ⅰ type to Ⅱ grade pathological clas-sification, accounting for 51.43% (18/35); Ⅱ type to grade Ⅲ pathological classification, accounting for 55.56% (25/45). Helicobacter pylori infection classification of the severity and pathological grading was significantly positive correlation, Helicobacter pylori infection, the more obvious, the higher the level of pathology.Conclusion Classification, Henoch Schonlein purpura nephritis in children with clinical features and pathology of pathogenic bacteria infection is closely re-lated to the pathological damage through clinical type, patho-gen infection, immune complex pathogenesis in children with Henoch Schonlein purpura nephritis ratings, recommenda-tions should be performed early renal biopsy in children with Henoch Schonlein purpura nephritis, to determine the patho-logical classification, so as to provide a powerful reference for the selection of appropriate treatment programs.