中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
1期
91-95
,共5页
段玉燕%赵凯姝%李青梅%马青山%张丽%邹秋阳
段玉燕%趙凱姝%李青梅%馬青山%張麗%鄒鞦暘
단옥연%조개주%리청매%마청산%장려%추추양
病理学%儿童%紫癜性肾炎%尿蛋白定量
病理學%兒童%紫癜性腎炎%尿蛋白定量
병이학%인동%자전성신염%뇨단백정량
Pathology%Child%Henoch-Schonlein purpura nephritis%Urine protein quantitation
目的：探讨紫癜性肾炎（HSPN）患儿的尿蛋白定量与肾脏病理特点及其相关性，以提高对本病的认识，指导治疗。方法收集2009年9月至2013年6月期间收治于吉林大学第一医院小儿肾病科，并行肾脏穿刺活检的92例HSPN患儿，对其24 h尿蛋白定量、肾组织病理学等进行回顾性分析。结果肾脏病理以Ⅲ级以上最多见，为60例（65.2%）。正常尿蛋白定量组肾病理损害较轻，以Ⅱ级以下为主。轻中重度蛋白尿组之间肾小球病理分级均较重，以Ⅲ级以上为主，随尿蛋白的增加，肾小球病理分级有逐渐加重趋势。肾小管间质病变：尿蛋白定量正常组肾小管病理分级为＋级，改变较轻。轻度、中度及重度蛋白尿组之间肾小管间质分级为＋～＋＋，分级改变无显著差异（P＞0.05）。92例中IgA＋IgG＋IgM沉积型所占比例最大（30.4%），1例无任何免疫物沉积。28例IgA＋IgG＋IgM沉积型所对应的肾小球病理分级主要在Ⅲ级以上（92.9%），病理分级与IgA＋IgG＋IgM沉积正相关（P＜0.05）。轻度及重度蛋白尿组均以IgA＋IgG＋IgM沉积为主，分别占37.0%、37.5%，中度蛋白尿组以单纯 IgA 沉积常见（34.6%），尿蛋白定量分度与免疫沉积物分型之间无显著相关性（P＞0.05）。免疫沉积物中伴有C3沉积者71例（77.2%），分级以Ⅲ级以上为主，C3沉积与肾脏病理分级呈正相关（P＜0.05）。结论蛋白尿是影响 HSPN 肾脏病理的因素之一，肾脏病理损害程度与24 h尿蛋白定量水平不一定平行。免疫复合物沉积为IgA＋IgG＋IgM的病理改变相对较重。C3沉积和病理分级有相关性。
目的：探討紫癜性腎炎（HSPN）患兒的尿蛋白定量與腎髒病理特點及其相關性，以提高對本病的認識，指導治療。方法收集2009年9月至2013年6月期間收治于吉林大學第一醫院小兒腎病科，併行腎髒穿刺活檢的92例HSPN患兒，對其24 h尿蛋白定量、腎組織病理學等進行迴顧性分析。結果腎髒病理以Ⅲ級以上最多見，為60例（65.2%）。正常尿蛋白定量組腎病理損害較輕，以Ⅱ級以下為主。輕中重度蛋白尿組之間腎小毬病理分級均較重，以Ⅲ級以上為主，隨尿蛋白的增加，腎小毬病理分級有逐漸加重趨勢。腎小管間質病變：尿蛋白定量正常組腎小管病理分級為＋級，改變較輕。輕度、中度及重度蛋白尿組之間腎小管間質分級為＋～＋＋，分級改變無顯著差異（P＞0.05）。92例中IgA＋IgG＋IgM沉積型所佔比例最大（30.4%），1例無任何免疫物沉積。28例IgA＋IgG＋IgM沉積型所對應的腎小毬病理分級主要在Ⅲ級以上（92.9%），病理分級與IgA＋IgG＋IgM沉積正相關（P＜0.05）。輕度及重度蛋白尿組均以IgA＋IgG＋IgM沉積為主，分彆佔37.0%、37.5%，中度蛋白尿組以單純 IgA 沉積常見（34.6%），尿蛋白定量分度與免疫沉積物分型之間無顯著相關性（P＞0.05）。免疫沉積物中伴有C3沉積者71例（77.2%），分級以Ⅲ級以上為主，C3沉積與腎髒病理分級呈正相關（P＜0.05）。結論蛋白尿是影響 HSPN 腎髒病理的因素之一，腎髒病理損害程度與24 h尿蛋白定量水平不一定平行。免疫複閤物沉積為IgA＋IgG＋IgM的病理改變相對較重。C3沉積和病理分級有相關性。
목적：탐토자전성신염（HSPN）환인적뇨단백정량여신장병리특점급기상관성，이제고대본병적인식，지도치료。방법수집2009년9월지2013년6월기간수치우길림대학제일의원소인신병과，병행신장천자활검적92례HSPN환인，대기24 h뇨단백정량、신조직병이학등진행회고성분석。결과신장병리이Ⅲ급이상최다견，위60례（65.2%）。정상뇨단백정량조신병리손해교경，이Ⅱ급이하위주。경중중도단백뇨조지간신소구병리분급균교중，이Ⅲ급이상위주，수뇨단백적증가，신소구병리분급유축점가중추세。신소관간질병변：뇨단백정량정상조신소관병리분급위＋급，개변교경。경도、중도급중도단백뇨조지간신소관간질분급위＋～＋＋，분급개변무현저차이（P＞0.05）。92례중IgA＋IgG＋IgM침적형소점비례최대（30.4%），1례무임하면역물침적。28례IgA＋IgG＋IgM침적형소대응적신소구병리분급주요재Ⅲ급이상（92.9%），병리분급여IgA＋IgG＋IgM침적정상관（P＜0.05）。경도급중도단백뇨조균이IgA＋IgG＋IgM침적위주，분별점37.0%、37.5%，중도단백뇨조이단순 IgA 침적상견（34.6%），뇨단백정량분도여면역침적물분형지간무현저상관성（P＞0.05）。면역침적물중반유C3침적자71례（77.2%），분급이Ⅲ급이상위주，C3침적여신장병리분급정정상관（P＜0.05）。결론단백뇨시영향 HSPN 신장병리적인소지일，신장병리손해정도여24 h뇨단백정량수평불일정평행。면역복합물침적위IgA＋IgG＋IgM적병리개변상대교중。C3침적화병리분급유상관성。
Objective To investigate the urine protein quantitation and renal pathological features of Henoch-Schonlein purpura nephritis and their relationship in children. Our study is to deepen the understanding of HSPN and provide references for the treatment. Methods A total of 92 HSPN patients with a renal biopsy were admitted to the pediatric nephrology of the First Hospital of jilin University from September 2009 to June 2013. 24-hour urinary protein quantity and renal histopathology were collected and analyzed. Results The majority of pathological changes of HSPN were above grade Ⅲ with 60 cases(65.2%). The group with normal urinary protein quantitative had mild pathological changes and mainly were grade Ⅱ or below. Renal pathological changes between light moderately severe proteinuria groups were heavier and mainly were above grade Ⅲ, children of the urinary protein with proteinuria increase, glomerulus pathological grade had increased tendency. Tubulointerstitial lesions: The group with normal urinary protein quantitative were grade+ and had mild pathological changes. Light moderately severe proteinuria groups were grade + to ++, and no significant difference in grade existed among them(P>0.05). Of all the 92 patients, the type of co-deposition of immunoglobulins A, G and M accounted 30.4%, and one case had no deposition. Twenty-eight cases with co-deposition of immunoglobulins A, G and M were mainly over grade Ⅲ(92.9%), the type of immunogolobulins and pathologic change took significant difference statistically(P<0.05). Light and severe proteinuria groups mainly had co-deposition of immunogolobulins A, G and M, respectively 37.0% and 37.5%, while moderately proteinuria groups mainly had deposition of immunoglobulins A(34.6%). There was no significant difference statistically between the type of immunoglobulins and the level of proteinuria(P>0.05). 71 patients of 92 HSPN patients had C3 deposition with mainly over grades Ⅲ. C3 deposition was associated with pathologic classification(P<0.05). Conclusion Albuminuria is one of the factors that affect HSPN renal pathology. The renal pathological damage was always in parallel with the level of 24-hour urinary protein quantity in HSPN children. The sever renal pathological manifestations came with co-deposition of immunoglobulins A, G and M in the glomeruli. C3 deposition are associated with pathologic classification.
