| 李建,徐达良,朱颖.儿童过敏性紫癜性肾炎病理特点及Ⅱb 级以上危险因素分析[J].安徽医药,2022,26(5):895-899. |
| 儿童过敏性紫癜性肾炎病理特点及Ⅱb 级以上危险因素分析 |
| Pathological characteristics of children with Henoch-Schonlein purpura nephritis and analysis of risk factors above grade Ⅱb |
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| DOI：10.3969/j.issn.1009-6469.2022.05.011 |
| 中文关键词: 紫癜，过敏性 肾炎 儿童 过敏性紫癜性肾炎 病理特点 危险因素 |
| 英文关键词: Purpura, Henoch-Schoenlein Nephritis Child Henoch-Schonlein purpura nephritis Pathological features Risk factors |
| 基金项目:安徽省自然科学基金面上项目(1608085MH203) |
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| 中文摘要: |
| 目的探讨过敏性紫癜性肾炎(HSPN)的病理特点并分析病理等级Ⅱb及以上的危险因素。方法回顾性分析2014年1月至2019年11月安徽医科大学附属省儿童医院诊断为HSPN并行肾活检的病儿174例，分析病理特点及影响病理等级的危险因素。结果HSPN病儿男性多见，男女比例为1.49∶1，年龄(9.04±2.85)岁。所有病例中，病理Ⅰ级17例(9.77%)，Ⅱ级54例(31.03%)，Ⅲ级103例(59.20%)，无Ⅳ级病例；病理分级与临床症状的严重程度呈正相关(rs=0.47，P<0.001)；肾小管间质分级与尿蛋白水平无明显相关性(rs=0.05，P=0.587)；免疫复合物沉积于肾小球系膜区103例、毛细血管袢28例、系膜区+毛细血管袢36例，无明显沉积者7例；92例呈团块状沉积、75例呈逗点状沉积；沉积物以IgA+IgM型病例数最多(141例，81.03%)，其次为IgA+IgM+IgG型(15例，8.62%)。有补体C3沉积(113例，64.94%)与无补体C3沉积者(61例，35.06%)比较，病理等级Ⅱb及以上者差异有统计学意义。将174例病儿分为Ⅱb以下(非重度，63例)和Ⅱb及以上(重度，111例)，单因素分析显示两组在住院时间、肾外症状、大量蛋白尿、血清IgA和D-D二聚体方面差异有统计学意义；多因素Logistic 回归分析结果提示2种以上肾外症状、大量蛋白尿、D-D二聚体与病理级别为Ⅱb及以上有关。结论HSPN病儿病理类型以Ⅱ、Ⅲ级最常见，病理等级与临床分型和肾脏补体C3沉积相关，2种以上肾外症状、大量蛋白尿、D-D二聚体是HSPN病理级别为Ⅱb及以上的危险因素。 |
| 英文摘要: |
| Objective To explore the pathological characteristics of children with Henoch-Schonlein purpura nephritis (HSPN) and analyze the risk factors for pathological grade Ⅱ b and above.Methods This was a retrospective analysis of 174 children who were diag-nosed with HSPN and underwent renal biopsy from January 2014 to November 2019 in the Anhui Provincial Children's Hospital Affiliat-ed to Anhui Medical University. The pathological characteristics and risk factors affecting the pathological grade were analyzed.Results HSPN was more common in males, with a male-to-female ratio of 1.49∶1 and an age of (9.04±2.85) years. Among all the cases, there were 17 cases (9.77%) of grade I, 54 cases (31.03%) of grade Ⅱ, 103 cases (59.20%) of grade Ⅲ, and no cases of grade Ⅳ. The pathological grade was positively correlated with the severity of clinical symptoms (rs=0.47,P<0.001). There was no significant correlation between tu-bulointerstitial grading and urinary protein level (rs=0.05,P=0.587). The immune complexes were deposited in the glomerular mesangial area in 103 cases, the capillary loop in 28 cases, the mesangial area + capillary loop in 36 cases, and no obvious deposition in 7 cases.There were 92 cases of mass deposition and 75 cases of comma-shaped deposition. Most cases were IgA+IgM (141 cases, 81.03%), fol-lowed by IgA+IgM+IgG (15 cases, 8.62%). Compared with those with complement C3 deposition (113 cases, 64.94%) and those without complement C3 deposition (61 cases, 35.06%), there was a statistically significant difference in pathological grade Ⅱb and above. The 174 cases of children were divided into two groups below Ⅱb (nonsevere, 63 cases) and Ⅱb and above (severe, 111 cases). Univariate analysis showed that there were significant differences in hospital stay, extrarenal symptoms, massive proteinuria, serum IgA and DD di-mer between the two groups. Multivariate logistic regression analysis showed that two or more extrarenal symptoms, massive proteinuria, and D-D dimer were associated with pathological grade Ⅱb and above.Conclusion The most common pathological types of children with HSPN are grades Ⅱ and Ⅲ, and the pathological grades are related to clinical classification and renal complement C3 deposition.More than 2 extrarenal symptoms, massive proteinuria, and D-D dimer were risk factors for HSPN pathological grade Ⅱb and above. |
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