196例儿童肾活检临床与病理分析

发布时间：2018-01-20 01:58

本文关键词： 儿童肾活检临床病理并发症　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的总结肾穿刺活检患儿的临床与病理特点,了解肾活检的并发症、适应症及禁忌症,探讨临床与病理之间的关系,为临床医师提供帮助。方法收集2005年1月至2016年1月在广西医科大学第一附属医院儿科住院并成功进行肾穿刺活检196例患儿的临床和病理资料,回顾性分析其临床及病理特点。结果(1)196例肾活检患儿男123例(62.8%),女73例(37.2%),男:女=1.68:1,平均年龄10.81±2.41岁(4岁7月~15岁11月),其中原发性肾小球疾病(PGD)120例(61.2%),继发性肾小球疾病(SGD)74例(37.8%),遗传性肾病2例(1.0%)。(2)临床表现:PGD中最常见为肾病综合征(96例,80.0%),其次为血尿合并蛋白尿(10例,8.3%)、孤立性血尿(6例,5%);SGD中最常见为肾病综合征(40例,54.1%),其次为血尿合并蛋白尿(21例,28.4%)、孤立性蛋白尿(10例,13.5%)。(3)病理类型:PGD最常见为IgA肾病(32例,26.7%),其次为系膜增生性肾小球肾炎(25例,20.8%)、肾小球轻微病变(24例,20.0%);SGD中,狼疮性肾炎(LN)32例(43.2%),最常见为IV型(13例,40.6%),过敏性紫癜性肾炎(HSPN)32例(43.2%),最常见为IIb级(13例,40.6%),乙型肝炎病毒相关性肾炎(HBV-GN)10例(13.5%),最常见为膜性肾病(8例,80.0%)。(4)相关性分析:PGD的临床与病理之间具有一定相关性,临床表现为肾病综合征的其病理主要为肾小球轻微病变、系膜增生性肾小球肾炎及IgA肾病,而临床表现为血尿和(或)蛋白尿的其病理主要是IgAN。SGD的临床与病理之间无显著相关性。(5)肾活检并发症:出现肾活检并发症71例(36.2%),最常见为肾周血肿(51例,26.0%),其次为肉眼血尿、肉眼血尿合并肾周血肿(均为8例,4.1%)。结论(1)儿童超声引导下肾脏穿刺活检术成功率高,操作简便,肾脏损伤小。(2)本组资料中,儿童肾小球疾病以肾病综合征及血尿合并蛋白尿为主要表现,其病理类型多种多样。(3)儿童SGD常见为LN、HSPN和HBV-GN,其临床表现、病理类型和病理分级呈现多样性,临床与病理之间无一一对应关系。(4)儿童肾穿刺活检术并发症少,以出血性并发症常见,未出现严重并发症。
[Abstract]:Objective to summarize the clinical and pathological features of renal biopsy in children, to understand the complications, indications and contraindications of renal biopsy, and to explore the relationship between clinical and pathological. Methods Clinical and pathological data of 196 children with renal biopsy were collected from January 2005 to January 2016 in Department of Pediatrics, first affiliated Hospital of Guangxi Medical University. . The clinical and pathological features were retrospectively analyzed. Results there were 123 males (62.8%) and 73 females (37.2%), male: female: 1.68: 1. The mean age was 10.81 卤2.41 years old, 4 years old, July to 15 years old, November years old, of which 120 cases of primary glomerular disease were diagnosed as PGD and 61.2%). Secondary glomerular disease (SGD) 74 cases (37. 8%), hereditary nephropathy (2 cases) 1. 0% PGD (n = 96): nephrotic syndrome (n = 96). 80.0%, followed by hematuria with proteinuria in 10 cases, and isolated hematuria in 6 cases. The most common cases in SGD were nephrotic syndrome (n = 40), hematuria with proteinuria (n = 21) and solitary proteinuria (n = 10). The most common pathological type was IgA nephropathy (n = 32), followed by Mesangial proliferative glomerulonephritis (n = 25). There were 24 cases with slight glomerular lesions. In SGD, 32 cases of lupus nephritis (LNN) were found to be 43.2%, the most common were type IV (n = 13) and Henoch-Schonlein purpura nephritis (n = 32). The most common cases were IIb grade (n = 13), HBV-GNN (n = 10) and membranous nephropathy (n = 8). There was a certain correlation between the clinical and pathological changes of PGD, and the pathological features of the nephrotic syndrome were mainly slight glomerular lesions. Mesangial proliferative glomerulonephritis and IgA nephropathy. However, the pathology of hematuria and / or proteinuria was mainly related to the clinicopathology of IgAN.SGD. There was no significant correlation between the clinicopathology and the clinicopathology. There were 71 cases of renal biopsy complications (. 36.2). The most common hematoma was perirenal hematoma in 51 cases (26. 0%), followed by naked hematuria (8 cases), naked hematuria (8 cases) and perirenal hematoma (8 cases). Conclusion Ultrasound-guided renal biopsy in children has high success rate, simple operation and small renal injury. Nephrotic syndrome and hematuria with proteinuria are the main manifestations of glomerular disease in children. The pathological types of glomerular disease in children are varied. The SGD in children is usually LNN HSPN and HBV-GNN. The pathological types and pathological grades showed diversity, and there was no one-to-one correspondence between clinical and pathological. 4) the complications of renal puncture biopsy in children were few, and hemorrhagic complications were common, but no serious complications.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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