小儿孤立性血尿病理分析及临床诊断.docVIP

小儿孤立性血尿病理分析及临床诊断 　【摘要】 目的：探讨小儿孤立性血尿的病理类型。方法：结合肾组织光镜、电镜及免疫荧光检查结果对207例符合孤立性血尿诊断标准的患儿病历进行考察。结果：正常肾小球61例(29.5%)（其中局灶节段性肾小球透明样变性5例）；轻微病变72例(34.8%)；IgA肾病36例(17.4%)；薄基底膜肾病21例(10.1%)（其中正常肾小球7例，伴轻微病变14例）；系膜增生性肾小球肾炎13例(6.3%)（其中伴薄基底膜肾病2例）；局灶增生性肾炎4例(1.9%)。结论：轻微病变与正常肾小球占第一位，表现为孤立性血尿的IgA肾病病理变化相对较轻，为轻微病变或轻度系膜增生。所有病例均无新月体形成、肾小球硬化和小管间质受累。提示孤立性血尿患儿预后良好。 【关键词】 血尿；肾穿刺术；病理学，临床；儿童 ［ABSTRACT］ Objective: To explore the pathological type of children isolated hematuria. Methods: Investigated 207 children patients with conformed isolated hematuria by observing renal tissue with light microscope, electric microscope and immunofluorescent test respectively. Results: There were 61 patients with normal glomeruli (29.5%), including 5 patients with local segmental glomerulo hyaloid degeneration; 72 patients with minimal pathological change (34.8%); 36 with IgA nephropathy (17.4%); 21 with thin basement membrane nephropathy (10.1%), including 7 patients with normal glomeruli, 14 patients with minimal pathological change; 13 patients with membranous and proliferative glomerulonephritis (6.3%), including 2 patients with thin basement membrane nephropathy; 4 patients with local proliferative glomerulonephritis (1.9%). Conclusion: Most patients have normal or minimal glomeruli changed. Theses changes characterized as light pathological change of IgA nephropathy, showing light pathological change or light proliferatve mesenterium. All cases have no crescent formation, glomerulosclerosis or involvement of renal tubulointerstitial. All of these are suggestive of good prognosis. ［KEY WORDS］ Hematuria; Renal puncture; Pathology, clinical; Children 单纯性血尿，又称为孤立性血尿，是指仅尿中红细胞数量超过正常，为肾小球源性血尿，而无其他临床症状、实验室检查及肾功能改变者［1］。单纯性血尿在儿科并不少见，1998年，我国对224 291名2～14岁的健康儿童进行尿筛查，确诊为单纯性血尿者为942例(0.42%)。单纯性血尿是小儿肾小球疾病最常见的临床表现之一，其病理类型可多种多样［2］。笔者对我院1998年8月～2008年9月207例单纯性血尿患儿病历进行考察，探讨单纯性血尿的病理与临床诊断，现报告如下。 1 资料与方法 1.1 一般资料 本组207例患儿，为我院肾内科1998年8月～2008年9月收治的孤立性血尿患儿。男性118例，女性89例；年龄2～5 岁，平均(2.26±2.84)岁；肾活检前病程10 d～4