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目的 :回顾性分析过敏紫癜性肾炎 (HSPN)患者肾脏损害发生时间不同与临床病理及预后的联系。 方法 :1983年 1月至 2 0 0 1年 12月在我院肾活检确诊HSPN、明确记载皮肤紫癜与肾损害发生时间 ,并定期随访的患者 14 5例。分为三组 :组 1(肾损害早发组 ,n =84 ) ,肾炎在皮肤紫癜出现后 1个月内起病 ,病程中皮肤紫癜仅出现 1次 ;组 2 (反复紫癜 /肾损害迟发组 ,n =4 8) ,皮肤紫癜发作至少 2次或皮损发生 1个月后出现肾损害 ;组 3(肾损害首发组 ,n =13) ,肾损害出现在皮肤紫癜前。预后判断 ,正常 :无任何症状 ,尿检正常 ,肾功能正常 ;轻度尿检异常 :蛋白尿 (<1g/2 4h)或镜下血尿 ,肾功能正常 ,无高血压 ;恶化 :蛋白尿 (>1g/2 4h) ,肉眼血尿 ,高血压和(或 )肾功能不全。 结果 :三组间患者起病年龄、关节、胃肠受累率无显著性差异。组 1患者肾损害表现为尿检异常 /孤立性肉眼血尿 ,高血压和肾功能不全发生率低 ,肾活检病理以系膜增生为主 ,可伴少量细胞性新月体形成。组 2患者以中等量、大量蛋白尿多见 ,低白蛋白血症 2 2 9% ,病理上细胞性、细胞纤维性新月体、球囊粘连比例高。组 3患者病程最长 ,肾损害重 ,高血压发生率 15 4 % ,肉眼血尿发生率 38 5 % ,大量蛋白尿占 2 3 1% ,3例以急进性肾炎起病 ,病理
Objective: To retrospectively analyze the relationship between the time of renal damage and the clinicopathology and prognosis in patients with allergic purpura nephritis (HSPN). Methods: From January 1983 to December 2001, HSPN was diagnosed by renal biopsy in our hospital. There were 145 cases of purpura and renal damage, and the patients were followed up regularly. Divided into three groups: group 1 (early renal injury group, n = 84), nephritis onset within 1 month after the appearance of cutaneous purpura, skin purpura in the course of the disease only appeared once; group 2 (repeated purpura / kidney damage late Hair group, n = 4 8), skin purpura at least 2 times or 1 month after the occurrence of lesions of the kidney damage; group 3 (kidney damage in the first group, n = 13), kidney damage occurred in the skin before purpura. Prognosis, normal: no symptoms, normal urinalysis, normal renal function; mild urinalysis abnormalities: proteinuria (<1g / 2 4h) or microscopic hematuria, normal renal function, no hypertension; / 2 4h), gross hematuria, hypertension and / or renal insufficiency. Results: There was no significant difference in age, joint and gastrointestinal involvement between the three groups. Group 1 patients with renal damage manifested as abnormal urinalysis / isolated gross hematuria, hypertension and renal insufficiency, renal biopsy pathological mesangial proliferation may be accompanied by a small amount of cellular crescent formation. Group 2 patients with moderate, large amount of proteinuria more common, hypoalbuminemia 2 2 9%, pathological cells, crescent fibrous cells, high proportion of balloon adhesion. Group 3 patients had the longest course of disease, severe renal damage, hypertension rate of 15 4%, gross hematuria 38 5%, massive proteinuria 21 3%, 3 cases of acute nephritis onset, pathology