CAJ | 학술논문

目的：探讨伴有新月体的儿童紫癜性肾炎（ HSPN）的治疗新方法。方法：对33例伴有新月体的儿童HSPN进行临床分型及病理分级，患儿予大剂量甲基泼尼松龙冲击、泼尼松、霉酚酸酯等治疗。结果：33例HSPN患儿分为4种临床类型：（1）孤立性蛋白尿1例（3．0％）；（2）血尿和蛋白尿15例（45．5％）；（3）急性肾炎型4例（12．1％）；（4）肾病综合征型13例（39.4％）。病理分级：32例为Ⅲ级，即系膜增生，伴有＜50％肾小球新月体形成；1例Ⅴ级，中～重度系膜增生伴88％肾小球新月体形成。经新方案治疗后，33例HSPN患儿完全缓解30例，占91％，好转2例，死亡1例，其完全缓解率明显高于以往接受常规治疗的患儿。结论：儿童HSPN伴有新月体者使用大剂量甲基泼尼松龙冲击治疗＋序贯泼尼松＋霉酚酸酯治疗，其疗效好于以往常规治疗方案。
목적：탐토반유신월체적인동자전성신염（ HSPN）적치료신방법。방법：대33례반유신월체적인동HSPN진행림상분형급병리분급，환인여대제량갑기발니송룡충격、발니송、매분산지등치료。결과：33례HSPN환인분위4충림상류형：（1）고립성단백뇨1례（3．0％）；（2）혈뇨화단백뇨15례（45．5％）；（3）급성신염형4례（12．1％）；（4）신병종합정형13례（39.4％）。병리분급：32례위Ⅲ급，즉계막증생，반유＜50％신소구신월체형성；1례Ⅴ급，중～중도계막증생반88％신소구신월체형성。경신방안치료후，33례HSPN환인완전완해30례，점91％，호전2례，사망1례，기완전완해솔명현고우이왕접수상규치료적환인。결론：인동HSPN반유신월체자사용대제량갑기발니송룡충격치료＋서관발니송＋매분산지치료，기료효호우이왕상규치료방안。
Objective: To study the new therapy for Henoch-Schonlein purpura nephritis ( HSPN ) in children accompanied by crescent formation . Methods: 33 HSPN children were divided into 4 clinical types and 5 histological degrees respectively . All patients were treated with high-dose mythylprednisolone pulse therapy , prednisone, mycophenolate mofetil , etc. Results: 33 HSPN children were divided into 4 clinical types:(1) isolated proteinuria, 1 case(3.0%);(2) hematuria and proteinuria, 15 cases(45.5%);(3) acute nephritis type, 4 cases(12.1%);(4) nephrotic syndrome type, 13 cases(39.4%).About histological degrees, 32 cases were in grade Ⅲ( mesangial proliferation , all accompanied by <50%crescent formation ) , 1 case was in grade Ⅴ( moderate to severe mesangial proliferation , accompanied by 88%crescent formation ) .Treated with new therapy , 30 cases(91%) were complete remission, 2 cases were improved, and one died.The complete remission rate of this therapy was significantly higher than that of the past treatment . Conclusion: Treated with high-dose mythylprednisolone pulse therapy , prednisone , mycophenolate mofetil etc , HSPN children accompanied by crescent formation have better effects compared with the past treatment .