CAJ | 학술논문

目的：探讨临床以蛋白尿为表现的儿童紫癜性肾炎（HSPN）的肾脏病理和临床特点。方法回顾性分析180例临床以蛋白尿为表现的HSPN患儿的临床和病理资料，并根据24 h尿蛋白定量进行分组比较。结果临床分型中以中度蛋白尿型最多（57例，31.7%），其次是大量蛋白尿型（51例，28.3%）、轻度蛋白尿型（46例，25.6%）和微量蛋白尿型（26例，14.4%）；根据国际儿童肾脏病研究协会（ISKDC）标准，病理分级以II级（92例，51.1%）和III级（73例，40.6%）最多。中度蛋白尿型的病理分级以II级（31例，54.4%）多见，大量蛋白尿型的病理分级以III级（33例，64.7%）多见。随着蛋白尿严重程度的增加，病理分级呈递增趋势，差异有统计学意义（χ2=39.54，P=0.002）。免疫病理分型以IgA+IgM沉积型多见（84例，46.7%），IgA+IgM+IgG沉积型次之（55例，30.6%）。免疫病理分型与病理分级及临床分型无相关性（P>0.05）。结论以蛋白尿为表现的HSPN患儿临床表现为大量蛋白尿者病理改变相对较重，但临床症状与病理损伤程度不完全一致。
목적：탐토림상이단백뇨위표현적인동자전성신염（HSPN）적신장병리화림상특점。방법회고성분석180례림상이단백뇨위표현적HSPN환인적림상화병리자료，병근거24 h뇨단백정량진행분조비교。결과림상분형중이중도단백뇨형최다（57례，31.7%），기차시대량단백뇨형（51례，28.3%）、경도단백뇨형（46례，25.6%）화미량단백뇨형（26례，14.4%）；근거국제인동신장병연구협회（ISKDC）표준，병리분급이II급（92례，51.1%）화III급（73례，40.6%）최다。중도단백뇨형적병리분급이II급（31례，54.4%）다견，대량단백뇨형적병리분급이III급（33례，64.7%）다견。수착단백뇨엄중정도적증가，병리분급정체증추세，차이유통계학의의（χ2=39.54，P=0.002）。면역병리분형이IgA+IgM침적형다견（84례，46.7%），IgA+IgM+IgG침적형차지（55례，30.6%）。면역병리분형여병리분급급림상분형무상관성（P>0.05）。결론이단백뇨위표현적HSPN환인림상표현위대량단백뇨자병리개변상대교중，단림상증상여병리손상정도불완전일치。
Objectives To explore the clinical features and pathological types of childhood Henoch-Sch?nlein purpura ne-phritis (HSPN)with proteinuria. Methods Clinical and pathological data of 180 children with HSPN presenting with proteinuria were retrospectively analyzed in groups according to 24-hour urinary protein levels. Results The moderate proteinuria (57 cases, 31.7%) was the most common clinical type, followed by high-grade proteinuria (51 cases, 28.3%), mild proteinuria (46 cases, 25.6%) and microalbuminuria (26 cases, 14.4%). According to the International Study of Kidney Disease of Children , the major pathological type of HSPN are grade II (92 cases, 51.1%) and grade III (73 cases, 40.6%). The main pathological changes of moderate proteinuria were grade II (31 cases, 54.4%), and the main pathological changes of high-grade proteinuria were grade III (33 case, 64.7%). The pathological grade was progressively increased along with severity of proteinuria. The difference was statistically significant (χ2=39.54, P=0.002). The main immunopathological type was IgA+IgM (84 cases, 46.7%), followed by IgA+IgM+IgG (55 cases, 30.6%). No correlation was found among immunopathological typing, pathological typing and clinical typing (P>0.05). Conclusions The HSPN children with massive proteinuria show more severe pathological changes, but the se-verity of clinical symptoms is not completely consistent with the pathological damages.