儿童紫癜性肾炎临床与病理分析-儿科学专业论文.docxVIP

摘 要 儿童紫癜性肾炎临床与病理分析 研究生：俞蕾 导师：赵桂臣教授 摘 要 目的：探讨儿童紫癜性肾炎（Henoch-schonlein purpura nephritis, HSPN）的临床 和病理特点，指导治疗，改善预后。方法：回顾性分析 2000 年 1 月至 2008 年 10 月 在新疆维吾尔自治区人民医院儿科住院，诊断为紫癜性肾炎的 55 例患儿的临床及病 理资料。结果：1.临床特点：临床分型中以血尿和蛋白尿型最多，肾病综合征型次之， 单纯性血尿或蛋白尿型、急性肾炎型和急进行肾炎型占少数。临床上伴有消化道症 状的紫癜性肾炎患儿比不伴有消化道症状的患儿容易出现肾病水平蛋白尿（P＜ 0.05）。伴有肉眼血尿的患儿比仅有镜下血尿的患儿容易出现肾病综合征（ P＜0.05）。 2.病理特点：根据 ISKDC 标准，肾脏病理分级以Ⅱ级和Ⅲ级最多。小管-间质病理分 级、免疫沉积物分型、C3 沉积和病理分级有相关性（P＜0.05）。3.临床和病理特点： 临床分型与病理分级有相关性（P＜0.05），临床分型越重，肾脏病理损害越重。4. 预后和病理特点：预后结果与病理分级有相关性（ P＜0.05），病理分级越重，预后越 不佳。结论：55 例 HSPN 临床以血尿和蛋白尿型及肾病综合征型为主，病理分级以 Ⅱ级和Ⅲ级最常见。小管-间质病理分级与肾脏病理损害的严重程度一致；免疫病理 沉积物分型为 IgA+IgG+IgM 型的 HSPN，病理分级重；伴有 C3 沉积的 HSPN 病理分 级重。55 例 HSPN 临床症状与病理损伤的严重程度一致；尿蛋白随着消化道受累程 度的加重而增加；肉眼血尿与肾脏损害的严重程度有关。HSPN 临床表现重、病理分 级高，则预后越差。 关键词: 紫癜性肾炎；儿童；临床；病理 新疆医科大学医学硕士学位论文 Clinical and Pathological Analysis of Henoch-Schonlein Purpura Nephritis of Children Postgraduate:YU Lei Supervisor:ZHAO Gui-Chen Professor Abstract Objective: To explore clinical and pathological features of children with Henoch- schonlein purpura nephritis(HSPN). To provide reference of the treatment, and to improve the life quality of the patients. Methods : A total of 55 patiens with HSPN were admitted to our depatement from January 2000 to Octomber 2008 in the people’s hospital of Xin jiang Vigur Antonomous Region. Their clinical and pathological datas were retrospectively collected and analyzed.Results: 1.Clinical characteristics: Hematuria and proteinuria was the most common clinical type, nephrotic syndrome came after it, while simple hematuria or proteinuria and acute glomerulonephritis and rapidly progressive glomerulonephritis were less.The percentage of nephrotic level porteinuia in cases with gastrointestinal symptoms was higher than that in cases without gastrointestinal symptoms(P＜0.05). The percentage of nephrotic syndrome in cases with gross hemaururia was higher than that in cases with microscopic hemaururia(P＜0.05). 2.Pathologic features: According to the standard of ISKDC, the