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目的探讨儿童紫癜性肾炎(HSPN)的临床分型与肾脏病理之间的关系。方法对74例HSPN患儿进行临床分型、病理分型、免疫组织化学分析。结果临床分型为轻型占86.5%,肾病综合征型占12.2%,慢性肾炎占1.3%。病理分型中以Ⅱ、Ⅲ较为多见,分别占44.6%、48.6%。临床分型与病理类型结合显示:单纯血尿病理分级为Ⅱ级占75.0%,Ⅲ级占16.7%;单纯蛋白尿病理分型中Ⅱ级占33.3%,Ⅲ级占66.7%;血尿+蛋白尿组Ⅱ级占40.8%,Ⅲ级占55.1%,肾病综合征型Ⅱ级、Ⅲ级分别占33.3%、55.6%。尿蛋白阳性患儿出现轻度水平的蛋白尿的患儿占67.7%,中度蛋白尿占17.7%,大量蛋白尿占14.5%。免疫病理分型以IgA+IgM+C3和IgA+IgG+IgM+C3型最多见,分别占40.5%、25.7%,其相对应的病理类型上主要表现为Ⅱ、Ⅲ级。结论紫癜性肾炎临床分型以轻型为主,病理分级以Ⅱ、Ⅲ级多见。蛋白尿患儿随尿蛋白的增加,病理类型有逐渐加重倾向,说明紫癜性肾炎临床分型的严重性与病理改变有密切的联系。但也存在不一致性,即轻型临床分型的患儿尤其是单纯血尿型,肾脏病理出现了不同程度的改变,故单纯血尿型是有必要行肾穿检查的。
Objective To investigate the relationship between the clinical classification of children with HSPN and the pathology of kidney. Methods 74 cases of children with HSPN clinical classification, pathological type, immunohistochemical analysis. Results The clinical classification was light type accounted for 86.5%, nephrotic syndrome type accounted for 12.2%, chronic nephritis accounted for 1.3%. Pathological type Ⅱ, Ⅲ more common, accounting for 44.6%, 48.6%. The clinical classification and pathological type showed that pathological grade of hematuria was 75.0% of grade Ⅱ and 16.7% of grade Ⅲ, Ⅱ grade of simple proteinuria accounted for 33.3% and Ⅲ grade accounted for 66.7%, hematuria + proteinuria group Grade II accounted for 40.8%, Grade III accounted for 55.1%, Grade II and III of nephrotic syndrome accounted for 33.3% and 55.6% respectively. Urine protein-positive children with mild proteinuria accounted for 67.7% of children, moderate proteinuria accounted for 17.7%, a large amount of proteinuria accounted for 14.5%. Immunopathological types were most common in IgA + IgM + C3 and IgA + IgG + IgM + C3 types, accounting for 40.5% and 25.7% respectively, and their corresponding pathological types were mainly Grade II and III. Conclusion The clinical classification of purpuric nephritis is light and the pathological grade is more common in grade Ⅱ and Ⅲ. With the increase of urinary protein in children with proteinuria, the pathological type gradually aggravates, indicating that the severity of clinical classification of purpura nephritis is closely related to the pathological changes. However, there are also inconsistencies, that is, children with mild clinical classification, especially hematuria, renal pathology appeared varying degrees of change, so the simple hematuria is necessary renal screening.