儿童IgA肾病与过敏性紫癜性肾炎的临床和病理的对比分析-儿科学专业论文.docxVIP

摘 要 儿童 IgA 肾病与过敏性紫癜性肾炎的 临床和病理比分析 研究生：依帕古力.斯米江 导师：赵桂臣 摘 要 目的:对比分析 IgA 肾病和过敏性紫癜性肾炎(HSPN)在临床表现、分型及肾脏病 理检测结果,探讨两者的异同关系。方法:对经肾脏活组织检查术（即肾活检）确诊的 27 例 IgA 肾病及 37 例过敏性紫癜性肾炎患儿进行详细的临床及病理对比分析。结果： IgA 肾病及 HSPN 在民族、性别间的构成及诱因方面无统计学差异（ P0.05）。59.5% 的 HSPN 患儿发病年龄在 7~12 岁之间,而在 IgA 肾病中该年龄段仅占 33.3%,差异有 显著意义(P0.05)。IgA 肾病与 HSPN 临床表现都以血尿伴蛋白尿居多，分别占 41.0% 和 43.0%, 但 IgA 肾病的急进性肾炎及肉眼血尿的发生率高于 HSPN，分别为 22.2%、 2.7%，48.2%、2.7%，差异均有统计学意义 (P0.05)。HSPN 肾外症状均有皮肤紫 癜,62.2%有胃肠症状,46%有关节痛,而 IgA 肾病仅 3.7%有腹痛,无皮疹、关节痛，差异 均有统计学意义(P 0.05)。在肾脏理改变上,肾小管萎缩、轻微病变的差异有统计学 意义(P0.05)。免疫病理上，大多数 IgA 肾病(19 例,70.0%)为 IgA 或伴 IgM 沉积，而 HSPN 患儿肾小球免疫沉积物中含有 IgG 占多数， 差异有统计学意义(P0.05)。病 理分级方面, 两组均以Ⅰ级及Ⅱ级病例居多,分别占 59.6%、72.9%, 但各组间的差异 无统计学意义 (P0.05) 。.结论：gA 肾病与 HSPN 在临床类型方面极其相似,但在临 床表现、病理变化、免疫机制上存在明显差异,上述对比分析结果支持它们是两个疾 病实体。 关键词: 儿童; 紫癜; 肾小球肾炎; IgA 新疆医科大学医学硕士学位论文 Clinical and pathological analysis comparing IgA nephropathy with Henoch-Schonlein purpura nephritis in children Postgraduate: Yipaguli Supervisor: ZhaoGuichen professor Abstract Objective: IgA nephropathy and Henoch-Schonlein purpura nephritis (HSPN) are very similar in immuno-pathological changes, and therefore some nephrologists considered that they are substantially one disease entity caused by IgA immune abnormalities, and IgA nephropathy is, in fact, a kind of HSPN without rashes· The present study aimed to characterize their relationship through clinico-pathological comparison between IgA nephropathy and HSPN. Methods : Twenty-seven children with IgA nephropathy aged from 2 to 18 years and thirty-seven children with HSPN aged between 5 to 18 years were enrolled in this study· Their clinical manifestations, and renal biopsies collected and analyzed· Renal pathological findings in light microscopy, immuno- fluorescence were analyzed and also compared between 27 children with IgA nephropathy and 37 children with HSPN . Results: There are no significant differences between IgAN and HSPN on sex, race and risk factors. The age of onset was 7~12 years in 59.5% children