早期肾活检在尿检正常型儿童紫癜性肾炎中的临床-第三军医大学学报.DOCVIP

早期肾活检在尿检正常型儿童紫癜性肾炎中的临床意义 干 毅1 李祥丽1王会凤1游忠岚2王墨3 （1 563003 遵义 遵义医学院附属医院儿科 2 400038 重庆 第三军医大学全军感染病研究所 3 400014 重庆 重庆医科大学附属儿童医院肾脏免疫科） 摘要：目的 通过回顾性分析早期尿检正常型紫癜性肾炎患儿肾活检病理及预后情况，探讨早期肾活检重要性。方法 选择早期尿检正常但尿微量蛋白阳性的紫癜性肾炎患儿，按照以早期尿微量蛋白持续阳性或病程中出现尿蛋白作为肾活检指标，分为两组，探讨其肾活检病理及预后差别。统计学处理采用SPSS11.0软件。结果 所有早期尿检正常型紫癜性肾炎患儿，反复尿微量蛋白异常≥3次者，肾活检发现肾脏均有不同程度损害，其中Ⅱ级37例(53.6% ) ，III级27例（39.1%），IV级5例（7.3%）；早期肾活检组（以早期尿微量白蛋白持续阳性为指标）的病理损害程度低于待尿蛋白阳性再行肾活检组（fisher精确检验，p0.05），并且前者蛋白尿转阴时间显著短于后者（p0.01）。 结论 以尿微量蛋白持续阳性作为肾活检指标，进行早期肾活检，能及早发现肾脏损害，改善预后。 关键词 过敏性紫癜肾炎 尿微量蛋白 早期肾活检 Clinical significance of early stage renal biopsy for pur purpuric nephritis children with normal urine analysis Abstract：Objective Retrospectively analysis was perfornaed to reveal clinical significance of early stage renal biopsy for pur purpuric nephritis children with normal urine analysis. Method Purpuric nephritis children with normal Urine routine result and positive u-malb were enrolled and divided into two group. one group was taken early stage renal biopsy while u-malb is positive，the other group was taken renal biopsy while the urine protein is positive. Difference of renal biopsy and prognosis between two groups were analyzed. Result All the Purpuric nephritis children are founded renal impairment in different degree with renal biopsy，37 children（53.6%）with II degree impairment，27 children（39.1%）with III degree impairment，5（0.07%）with IV degree impairment. The renal impairment degree of early stage renal biopsy group is lower compared to the group with urine protein positive（fisher exact test，p0.05），and the course of urine protein disappearance of the former is obviously shorter than the latter（p0.01）. Conclusion Using the u-malb as indicator of early stage renal biopsy can reveal the renal impairment earlier and achieve better prognosis. Key words：Henoch-Schonlein purpura，u-malb，early stage renal biopsy 过敏性紫癜（Henoch-Schonlein purpura，HSP）是以全身小血管变态反应性炎症为主要病理改变的疾病，一般HSP患者以皮肤紫癜为首发症状，是儿科临床常见病。其临床表现多样，以非血小板减少性紫癜为突出表现，可伴有关节痛、腹痛、胃肠