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目的分析婴幼儿肾脏疾病临床病理的特点及婴幼儿肾穿刺安全进行的方法和意义。方法对临床诊断为肾脏疾病的227例婴幼儿进行经皮肾穿刺活检,肾脏病理组织分别进行光镜、免疫荧光和电镜观察。光镜标本做苏木精-伊红(HE)、过碘酸雪夫反应(PAS)、六胺银(PASM)和Masson染色,免疫荧光检测其肾组织中的IgG、IgM、IgA、C3、C4、C1q、Fibrin,204例标本同时行电镜检查。结果所有患儿肾穿刺均获成功,术后无明显并发症。有肾穿刺适应证的227例婴幼儿肾脏疾病中最常见的是肾病综合征(38.3%)、孤立性血尿(37.0%)和急性肾炎综合征(9.3%),继发性肾脏疾病相对较少(5.3%)。肾脏病理类型中最常见的是系膜增生性肾小球肾炎(62.6%)、IgA肾病(8.4%)和局灶节段性肾小球硬化(5.7%)。87例肾病综合征病理类型最常见的是系膜增生性肾小球肾炎(50例)、微小病变(11例)和局灶节段性肾小球硬化(9例);84例孤立性血尿病理类型最常见的是系膜增生性肾小球肾炎(68例)和IgA肾病(9例)。结论在不盲目扩大适应证的基础上,安全有效地进行婴幼儿肾穿刺,可以提高婴幼儿肾脏疾病的诊治水平。
Objective To analyze the clinicopathological characteristics of infant kidney disease and the method and significance of the safety of renal puncture in infants and young children. Methods Percutaneous renal biopsy was performed on 227 infants and young children with clinically diagnosed renal disease. The pathological tissues of kidney were observed by light microscopy, immunofluorescence and electron microscopy. Light microscopy was performed on hematoxylin and eosin (HE), periodic acid Schiff’s reaction (PAS), hexamine silver (PASM) and Masson staining, and IgG, IgM, IgA, C3, C4 , C1q, Fibrin, 204 cases simultaneously underwent electron microscopy. Results All patients had successful renal puncture, no significant postoperative complications. The most common of the 227 infants and young children with kidney puncture indications were nephrotic syndrome (38.3%), isolated hematuria (37.0%) and acute nephritic syndrome (9.3%), with relatively few secondary kidney diseases (5.3%). The most common renal pathological types were mesangial proliferative glomerulonephritis (62.6%), IgA nephropathy (8.4%) and focal segmental glomerulosclerosis (5.7%). 87 cases of nephrotic syndrome pathological types are the most common mesangial proliferative glomerulonephritis (50 cases), minimal changes (11 cases) and focal segmental glomerulosclerosis (9 cases); 84 cases of isolated hematuria The most common pathological types are mesangial proliferative glomerulonephritis (68 cases) and IgA nephropathy (9 cases). Conclusion Without blindly expanding the indications based on safe and effective infant kidney puncture, can improve the diagnosis and treatment of kidney disease in infants and young children.