儿童无症状血尿肾穿刺指征探讨

发布时间：2018-03-26 01:40

本文选题：无症状血尿　切入点：肾活检　出处：《临床儿科杂志》2017年07期

【摘要】：目的探讨无症状血尿儿童的肾穿刺指征。方法回顾分析485例无症状血尿儿童的肾脏病理类型。根据血尿程度及有无合并蛋白尿将入组患儿分为,镜下血尿组、肉眼血尿组和血尿合并蛋白尿组;其中镜下血尿组再根据血尿程度分为尿红细胞15/HPF组,15~30/HPF组和30/HPF组。结果 485例患儿中,男227例、女258例,平均(7.23±2.93)岁;镜下血尿组318例,最常见病理类型为轻微病变(64.8%),其次为局灶性肾小球病变(16.7%)和局灶节段性肾小球硬化(8.2%);肉眼血尿组119例,最常见病理类型也是轻微病变(26.1%),其次为Ig A肾病(24.4%)和系膜增生性肾小球疾病(20.2%);血尿合并蛋白尿组48例,最常见病理类型为Ig A肾病(29.2%)和轻微病变(29.2%)。镜下血尿组、肉眼血尿组和血尿合并蛋白尿组的病理类型分布差异有统计学意义(χ~2=152.03,P0.001);其中镜下血尿组的轻微病变比例最高;IgA肾病和系膜增生性肾小球肾炎比例在在肉眼血尿和血尿合并蛋白尿组中比例较高。镜下血尿组中,尿红细胞15/HPF组149例,(15~30)/HPF组96例,30/HPF组73例,三组间病理类型构成差异无统计学意义(χ~2=15.18,P=0.512);最常见病理类型均为轻微病变。结论无症状血尿者中,为肉眼血尿或者血尿合并蛋白尿者应尽早行肾穿刺明确病理诊断。
[Abstract]:Objective to study the renal puncture indications in children with asymptomatic hematuria. Methods the renal pathological types of 485 children with asymptomatic hematuria were retrospectively analyzed. The children were divided into two groups according to the degree of hematuria and the presence or absence of proteinuria. According to the degree of hematuria, the hematuria group was divided into 1530% HPF group and 30/HPF group according to the degree of hematuria. Results there were 227 males and 258 females with an average age of 7.23 卤2.93 years, 318 cases in the hematuria group. The most common pathological types were slight pathological changes (64.8%), focal glomerular lesions (16.7%) and focal segmental glomerulosclerosis (8.2%). The most common pathological types were mild pathological changes (26.1cm), IgA nephropathy (24.4kb) and Mesangial proliferative glomerular diseases (20.2g); hematuria with proteinuria group (48 cases), the most common pathological types were IgA nephropathy (29.2g) and mild pathological changes (29.2g). There was significant difference in the distribution of pathological types between hematuria group and hematuria combined with proteinuria group (蠂 ~ 2 / 2 152.03 / P 0.001), in which IgA nephropathy and Mesangial proliferative glomerulonephritis were the highest in microscopic hematuria group (P < 0.05), and the ratio of microscopic hematuria group and Mesangial proliferative glomerulonephritis group was higher than that in naked eye hematuria and blood group (P < 0.05). The proportion of urine combined with proteinuria was higher. There was no significant difference in pathological types among the three groups (蠂 ~ (2 / 2) 15.18) P ~ (0.512), and the most common pathological types were mild lesions. Conclusion in asymptomatic hematuria, there is no significant difference between the three groups. Renal puncture should be performed as early as possible for the diagnosis of gross hematuria or hematuria with proteinuria.
【作者单位】：上海交通大学医学院附属新华医院小儿肾脏内科;
【基金】：新华医院临床课题基金(No.15LC02)
【分类号】：R726.9

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