儿童IgA肾病临床与病理分析

发布时间：2018-05-06 19:55

  本文选题：儿童 + IgA肾病　； 参考：《山东大学》2014年硕士论文

【摘要】：研究背景：IgA肾病是儿童时期常见的肾小球疾病,肾活检免疫病理检查可见肾小球系膜区有以IgA为主的颗粒样沉积。以反复发作肉眼血尿或镜下血尿为主要临床表现,可伴有不同程度的蛋白尿。临床表现差异大,轻者仅表现镜下血尿,严重者呈急进性肾炎。其临床呈慢性进展过程,IgA肾病已成为导致终末期肾病的主要原因之一。虽然经过40多年长期的临床观察和病理研究,但由于IgA肾病的发病机制复杂,目前仍未完全清楚,其临床表现和病理的多样性和不平行性,目前尚无统一的临床分型和病理分类方法,更无统一和特效的治疗方案。积极应对IgA肾病已经成为儿科肾脏病医师的共识,及早诊断,根据不同临床表现和病理改变进行治疗,以改善患儿预后。 目的：本研究旨在分析儿童原发性IgA肾病的临床表现与病理特点,了解其临床表现与病理改变的关系,以指导临床治疗。 研究方法：对2006-2013年山东省立医院收治并经肾穿刺活检确诊的110例原发性IgA肾病患儿的临床资料进行回顾性分析,观察不同临床表现及病理类型的特点,了解其临床表现与病理分级的关系。 结果：(1)2006年1月至2013年12月,山东省立医院≤14岁经肾活检确诊的IgAN患儿共110例,资料完整者110例,男性多见,男：女为1.68：1,确诊年龄为8.64±2.29岁。(2)50%患儿起病有诱因,其中大多为上呼吸道感染,其次为胃肠道感染。(3)临床表现以肉眼血尿(伴或不伴蛋白尿)为主诉者最常见(65例,59.1%)。临床分型中以血尿蛋白尿型最常见54例(49.1%),其次为肾病综合征型40例(36.4%)。(4)病理分级以ⅠⅡ级(59例,53.6%)多见；免疫荧光检查以IgA类型的最多,有46例(41.8%)；(5)临床表现与病理分级之间存在显著相关性；免疫复合物沉积与WHO病理分型之间存在相关性；免疫复合物中IgA与C3沉积之间存在相关性,二者之间存在正相关；(6)IgA肾病预后的危险因素的logistic回归分析,尿蛋白为病理损害程度的独立危险因素。 结论：(1)儿童原发性IgAN男性多见。(2)临床表现以血尿蛋白尿型为多见。(3)病理表现以Ⅱ级和Ⅲ级为主。免疫荧光以IgA类型的多见,免疫复合物IgA与C3沉积存在正相关,临床表现较重者病理损害越重,单纯IgA沉积者病理损害较轻。(4)尿蛋白为病理损害程度的独立危险因素。
[Abstract]:Background: IgA nephropathy is a common glomerular disease in childhood. The glomerular Mesangial area has granular deposition mainly in glomerular Mesangial area by renal biopsy immunopathology. Repeated episodes of hematuria or hematuria under microscope are the main clinical manifestations, and may be accompanied by varying degrees of proteinuria. The clinical manifestation is big, the light person only presents the microscopic hematuria, the severe person presents the rapid progress nephritis. The chronic progression of IgA nephropathy has become one of the main causes of end-stage nephropathy. Although after more than 40 years of clinical observation and pathological study, the pathogenesis of IgA nephropathy is complex, and its clinical manifestations and pathology are diverse and non-parallel. At present, there is no uniform clinical classification and pathological classification, let alone a unified and effective treatment. It has become a common understanding among pediatric nephrologists to actively deal with IgA nephropathy, to diagnose early and treat according to different clinical manifestations and pathological changes in order to improve the prognosis of children. Objective: to analyze the clinical and pathological features of primary IgA nephropathy in children and to understand the relationship between its clinical manifestations and pathological changes in order to guide the clinical treatment. Methods: the clinical data of 110 children with primary IgA nephropathy admitted to Shandong Provincial Hospital from 2006 to 2013 and confirmed by renal biopsy were retrospectively analyzed, and the characteristics of different clinical manifestations and pathological types were observed. To understand the relationship between clinical manifestation and pathological grade. Results from January 2006 to December 2013, 110 cases of IgAN were diagnosed by renal biopsy in Shandong Provincial Hospital. The data were complete in 110 cases. Male: female was 1.68: 1. The diagnosis age was 8.64 卤2.29 years old. Most of them were upper respiratory tract infection, followed by gastrointestinal tract infection. The most common clinical manifestation was naked hematuria (with or without proteinuria) in 65 cases. In the clinical classification, the most common type of hematuria and proteinuria was 49.1%, followed by 40 cases of nephrotic syndrome with 36.4%, 59 cases with grade 鈪，

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