CAJ | 학술논문

目的：探讨儿童过敏性紫癜性肾炎（HSPN）的病理特点、病理评分分级与临床表现的关系。方法收集安徽省儿童医院肾内科2004年1月至2014年3月期间确诊为 HSPN 的77例患儿临床、病理资料，对其病理特点和临床表现进行回顾性分析。结果77例 HSPN 患儿中，腹型2l 例（27.3％）、关节型15例（19.5％），同时有关节及胃肠道症状28例（36.4％），无关节及胃肠道症状13例（16.9％）。单纯性血尿或单纯性蛋白尿21例（27.3％），血尿和蛋白尿37例（48.1％），肾病综合征型18例（23.4％），慢性肾炎型1例（1.3％）。肾脏病理分级中，Ⅰ级5例（6.5％）、Ⅱ级36例（46.8％）、Ⅲ级35例（45.5％）、Ⅳ级1例（1.3％）。HSPN 临床症状的严重程度与病理分级有相关性（rs ＝0.472，P ＝0.000）；蛋白尿症状明显者，病理级别较高。根据肾小球内沉积的免疫复合物不同可分为6型，以 IgA + IgM 沉积最多[48例（62.3％）]，其次为 IgA +IgG + IgM 沉积型[15例（19.5％）]；单纯 IgA 沉积11例（14.3％），IgA + IgG 沉积1例（1.3％），单纯 IgM 沉积者1例（1.3％），无 Ig 沉积者1例。其中伴补体 C3沉积59例（76.6％）。病理分级表现为Ⅲ级及以上者多见，有32例（54.2％），Ⅱ级25例（42.4％），Ⅰ级2例（3.4％）。不同免疫复合物沉积类型之间在病理类型的分布上差异无统计学意义，但补体 C3沉积与病理分级呈正相关（rs ＝0.361，P ＝0.001）。肾小球评分分级中，1级者62例（80.5％）、2级者15例（19.5％）；不同临床分组的肾小球评分分级不同，差异有统计学意义（χ2＝17.2，P ＝0.004）。77例（100％）患儿肾小管间质评分分级均为1级。结论 HSPN 患儿尿蛋白的严重程度、肾组织补体 C3沉积与病理分级相关，肾小球评分分级能较为准确地反映 HSPN 肾损害。
목적：탐토인동과민성자전성신염（HSPN）적병리특점、병리평분분급여림상표현적관계。방법수집안휘성인동의원신내과2004년1월지2014년3월기간학진위 HSPN 적77례환인림상、병리자료，대기병리특점화림상표현진행회고성분석。결과77례 HSPN 환인중，복형2l 례（27.3％）、관절형15례（19.5％），동시유관절급위장도증상28례（36.4％），무관절급위장도증상13례（16.9％）。단순성혈뇨혹단순성단백뇨21례（27.3％），혈뇨화단백뇨37례（48.1％），신병종합정형18례（23.4％），만성신염형1례（1.3％）。신장병리분급중，Ⅰ급5례（6.5％）、Ⅱ급36례（46.8％）、Ⅲ급35례（45.5％）、Ⅳ급1례（1.3％）。HSPN 림상증상적엄중정도여병리분급유상관성（rs ＝0.472，P ＝0.000）；단백뇨증상명현자，병리급별교고。근거신소구내침적적면역복합물불동가분위6형，이 IgA + IgM 침적최다[48례（62.3％）]，기차위 IgA +IgG + IgM 침적형[15례（19.5％）]；단순 IgA 침적11례（14.3％），IgA + IgG 침적1례（1.3％），단순 IgM 침적자1례（1.3％），무 Ig 침적자1례。기중반보체 C3침적59례（76.6％）。병리분급표현위Ⅲ급급이상자다견，유32례（54.2％），Ⅱ급25례（42.4％），Ⅰ급2례（3.4％）。불동면역복합물침적류형지간재병리류형적분포상차이무통계학의의，단보체 C3침적여병리분급정정상관（rs ＝0.361，P ＝0.001）。신소구평분분급중，1급자62례（80.5％）、2급자15례（19.5％）；불동림상분조적신소구평분분급불동，차이유통계학의의（χ2＝17.2，P ＝0.004）。77례（100％）환인신소관간질평분분급균위1급。결론 HSPN 환인뇨단백적엄중정도、신조직보체 C3침적여병리분급상관，신소구평분분급능교위준학지반영 HSPN 신손해。
Objective To investigate the correlations between the clinical manifestations based on pathologic grades and renal pathological features of Henoch - Schonlein purpura nephritis(HSPN)in children. Methods The clinical data of 77 patients with HSPN in the Department of Nephrology,Anhui Provincial Children's Hospital from Ja-nuary 2004 to March 2014 were retrospectively analyzed. The relationship between clinical manifestation and pathologi-cal features was analyzed. Results Among the 77 patients,21 cases(27. 3% )had both abdominal symptoms,and ar-thritis was reported in 15 cases(19. 5% ),28 cases(36. 4% )had abdominal symptoms and arthritis,and 13 cases (16. 9% )had no such symptoms. Hematuria and proteinuria were the most common clinical types[48. 1%(37 / 77 ca-ses)],followed by simple hematuria or proteinuria[27. 3%(21 / 77 cases)],nephrotic syndrome[23. 4%(18 / 77 ca-ses)],and chronic nephritis[1. 3%(1 / 77 cases)]. The major of pathological changes in HSPN were grade Ⅱ[46. 8%(36 / 77 cases)]and grade Ⅲ[45. 5%(35 / 77 cases)],the minority of them were grade Ⅰ[6. 5%(5 / 77 cases)]and grade Ⅳ[1. 3%(1 / 77 cases)]. The severity of urine protein was positively associated with pathologic classification (r s = 0. 472,P = 0. 000). According to the glomerular deposition of immune complex,there were 6 types. The percen-tage of deposition of IgA + IgM was 62. 3%(48 / 77 cases),IgA + IgG + IgM was 19. 5%(15 / 77 cases),IgA 14. 3%(11 / 77 cases),that of IgA + IgG 1. 3%(1 / 77 cases),and the IgM 1. 3%(1 / 77 cases),no Ig 1. 3%(1 / 77 cases). In these cases,76. 6%(59 / 77 cases)had complements C3 deposition;pathologic stage characterized by Ⅲ level and a-bove were common[54. 2%(32 / 59 cases)],Ⅱ level 42. 2%(25 / 29 cases),Ⅰ level 3. 4%(2 / 59 cases). Among the different types of immune complex depositions,there was no statistically significant difference in pathological types of distribution,while the clinical type and complements C3 deposition were significantly associated with pathologic classifi-cation(rs = 0. 361,P = 0. 001). Sixty - two cases were rated as level 1(80. 5% ),and 15 cases was level 2(19. 5% );in different clinical group,rating in glomeruli was statistically different(χ2 = 17. 2,P = 0. 004). Renal tubular interstitial rating of all the patients were level 1(100% ). Conclusions The severity of urine protein,complements C3 deposition is associated with pathologic classification. Pathologic classification can basically reflect the renal damage in HSPN.