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目的探讨过敏性紫癜肾炎(HSPN)临床与病理特点。方法回顾性分析1999年1月至2008年12月间在我院肾科肾活检并结合临床确诊的122例HSPN患儿的临床及病理。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/24h)或镜下血尿,肾功能正常,无高血压;恶化:蛋白尿(>1g/24h),肉眼血尿,高血压和(或)肾功能不全。结果Ⅱ级97例(79.5%),Ⅲ级24例(19.7%)。两组患者的治愈率分别为77.7%和42.1,(P<0.01)。HSPN小管间质的损害(TIL)情况:肾小管间质无损害者占16.3%,轻度损害者占55.9%,中度损害者占22.1%,重度占5.7%。TIL明显者,病情加重,表现为血压升高、蛋白尿加重、肾功能及肾小管功能明显下降。肾小管间质与血肌酐之间显著相关(P<0.01)。肾小管间质损害越重,系膜增殖程度、新月体及球性硬化的积分也越高。结论儿童过敏性紫癜肾炎的病理分型与其进展和预后密切相关。临床高血压、蛋白尿、新月体的发生和发展,特别是肾小管间质损害程度是HSPN进展的重要指标。
Objective To investigate the clinical and pathological features of Henoch-Schonlein purpura nephritis (HSPN). Methods The clinical and pathological features of 122 HSPN cases diagnosed in our hospital from January 1999 to December 2008 were analyzed retrospectively. Prognosis, normal: no symptoms, normal urinalysis, normal renal function; mild urinalysis abnormalities: proteinuria (<1g / 24h) or microscopic hematuria, normal renal function, no hypertension; 24h), gross hematuria, hypertension and / or renal insufficiency. Results Grade Ⅱ 97 cases (79.5%), Ⅲ grade 24 cases (19.7%). The cure rates for both groups were 77.7% and 42.1, respectively (P <0.01). HSPN TIL: 16.3% of tubulointerstitial lesions, 55.9% of mild lesions, 22.1% of moderate lesions and 5.7% of severe injuries. TIL significantly, the condition worsened, manifested as elevated blood pressure, increased proteinuria, renal function and renal tubular function decreased significantly. Tubular interstitial and serum creatinine were significantly correlated (P <0.01). The more severe tubulointerstitial damage, mesangial proliferation, crescent and the higher the score of sclerosis. Conclusion The pathological classification of children with Henoch-Schonlein purpura nephritis is closely related to its progress and prognosis. Clinical hypertension, proteinuria, the occurrence and development of crescent, especially the degree of tubulointerstitial injury is an important indicator of the progress of HSPN.