摘要
目的分析儿童狼疮性肾炎(LN)的临床及病理特点,探讨两者之间的相关性。方法对59例LN患儿的临床和病理资料进行回顾性分析。结果临床分型以肾病综合征型(NS型)最为常见(44.1%),其次为急性肾炎型(AGN型,23.7%)、孤立性血尿和(或)蛋白尿型(IH/P型,22.0%),急进性肾炎型和慢性肾炎型少见。病理分型以Ⅳ-G(A)和Ⅳ-G(A/C)型最常见,分别占40.7%和15.3%,其次为Ⅴ+Ⅲ型(8.5%)、Ⅴ+Ⅳ型(6.8%)和Ⅱ型(6.8%),Ⅵ型(5.1%)和Ⅰ型(1.7%)少见。临床分型为NS型者,病理多为Ⅳ型(65.4%),其次为Ⅴ型(26.9%)。病理Ⅳ型者肾小管间质(TIL)损害程度最为严重。LN患儿肾活检时的sCr水平与TIL病变程度呈正相关(rs=0.639,P<0.01)。Ⅳ型LN患儿dsDNA阳性率最高(87.9%),血补体C3水平最低;各组不同病理分型LN患儿的ESR、ANA、抗Sm抗体、抗RNP抗体、抗SSA抗体和抗SSB抗体阳性率之间的差异无统计学意义。结论LN患儿的临床表现与肾脏病理改变复杂多样,两者有一定的相关性,临床以NS型最常见,病理多为Ⅳ级,且Ⅳ级者TIL病变最重。肾活检对指导治疗和评估预后有重要意义。
Objective To investigate the relationship between the pathological classification and clinical manifestation of lupus nephritis （LN） in pediatric patients by renal biopsy and laboratory examination. Methods The clinical and pathological data of 59 cases of LN in pediatric patients were retrospectively analyzed. Results Of the 59 cases, the most common clinical manifestation was nephrotic syndrome （NS）, 44.1%; followed by acute glomerulonephritis （AGN）, 23.7%; isolated hematuria or proteinuria, 22.0%; and rare cases of rapidly progressive glomerulonephritis and chronic glomerulonephritis. The most common pathologic type was type Ⅳ-G （A）, （40.7%） and Ⅳ-G （A/C）（15.3%）, followed by type Ⅴ ＋ Ⅲ （ 8.5% ）, type Ⅴ ＋ Ⅳ （ 6.8% ） , type Ⅱ （ 6.8% ）. LN patients with nephrotic syndrome were commonly found in pathologic type Ⅳ （65.4%） and type Ⅴ （26.9%）. LN patients with pathologic type Ⅳ had the most serious tubular interstitial injury. There was a significantly positive correlation between serum creatinine level and severity of the tubular interstitial injury in renal biopsy （r_s= 0.639, P 〈 0.01）. Patients with pathologic type Ⅳ had the highest positive rate of anti-dsDNA and the lowest level of serum complement. There are no differences in positive rates of antinuclear antibody （ANA） , anti-Sm, anti-RNP, anti-SSA, anti-SSB, and ESR between patients with different pathologic types. Conclusions There are some relationships between the clinical and pathological features of LN in pediatric patients. NS was the most common clinical manifestation which had a significant tendency to have the pathologic type Ⅳ and tubular interstitial injury. Promotion renal biopsy was important in diagnosis, treatment and prognosis of LN in pediatric patients.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2009年第4期317-320,共4页
Journal of Clinical Pediatrics
关键词
儿童
狼疮性肾炎
临床
病理
children
lupus nephritis
clinic
pathology
