57例儿童狼疮性肾炎临床与病理分析

发布时间：2018-05-24 22:20

  本文选题：儿童 + 狼疮性肾炎　； 参考：《广西医科大学》2012年硕士论文

【摘要】：目的总结儿童狼疮性肾炎（lupus nephritis，LN）的临床表现与肾脏病理特点，探讨其临床表现与肾脏病理之间的相关性，为指导临床治疗提供帮助。 方法收集2005年1月至2010年12月在广西医科大学第一附属医院住院并进行肾活检确诊的57例LN患儿的临床和病理资料，根据WHO2003年诊断标准进行肾脏病理分型，回顾性分析其临床表现、实验室检查和肾脏病理资料。 结果⑴57例LN患儿男14例（24.6%），女性43例（75.4%），男:女=1:3.07，发病年龄为6~15岁，平均（12±2.64岁）。⑵以肾脏受累为首发症状者37例（65.5%），最常见的临床分型为肾病综合征型28例（49.1%），孤立性血尿和(或)蛋白尿型15例（26.3%），其次为急性肾炎型8例（14%），慢性肾炎型3例，急进性肾炎型2例。肾外症状包括蝶形红斑（57.9%），发热（56.1%），关节疼痛（36.8%），光敏感（21.1%）。实验室检查：抗核抗体阳性（94.7%），低补体血症（91.2%），贫血（80.7%），抗dsDNA阳性（75.4%），高IgG血症（49.1%），电解质紊乱（45.6%）。⑶肾脏病理分型以Ⅳ型最常见（32例，56.1％），其次为Ⅱ型（11例，19.3％），再次Ⅲ型、Ⅴ型、Ⅴ+Ⅲ型和Ⅴ+Ⅳ型（各3例，5.3％），Ⅰ型2例（3.5％），Ⅵ型未见。⑷临床分型为NS型的28例患儿，病理类型大多为Ⅳ型（78.6％）；临床分型为孤立性血尿和(或)蛋白尿型的11例，病理类型呈多样性。Ⅳ型LN的临床类型以肾病综合征型为主（68.8%）。⑸相关分析：病理分型与临床分型无显著相关性，病理分型与肾外症状和实验室检查指标无显著相关性。 结论儿童LN的临床表现与肾脏病理改变多种多样，临床分型以肾病综合征型、孤立性血尿和（或）蛋白尿型为多见，病理分型最常见为Ⅳ型。临床分型与病理分型之间具有一定的相关性，，但没有一对一的对应关系。
[Abstract]:Objective to summarize the clinical and pathological features of lupus nephilitis in children with lupus nephritis (LN) and to explore the correlation between its clinical manifestations and renal pathology in order to provide guidance for clinical treatment. Methods from January 2005 to December 2010, 57 cases of LN children who were hospitalized in the first affiliated Hospital of Guangxi Medical University and confirmed by renal biopsy were collected. According to the annual diagnostic criteria of WHO2003, renal pathological classification was performed. The clinical manifestation, laboratory examination and renal pathological data were analyzed retrospectively. Results among 157 cases of LN, 14 cases were male (24.6%) and 43 cases were female (75.45.47%), male: female 1: 3.07, the age of onset was 615 years old. The average age of 12 卤2.64 years old was 12 卤2.64 years old. 37 cases with kidney involvement as the first symptom, 28 cases with nephrotic syndrome type and 49.1%, 15 cases with isolated hematuria and / or proteinuria type, 8 cases with acute nephritis type and 3 cases with chronic nephritis type, were diagnosed as acute nephritis type (n = 8) and chronic glomerulonephritis type (n = 3), the most common clinical types were nephrotic syndrome type (n = 28), isolated hematuria type (n = 15) and / or proteinuria type (n = 15). Two cases of acute nephritis. The extrarenal symptoms included butterfly erythema 57.9%, fever 56.1%, joint pain 36.8%, light sensitivity 21. 1%. Laboratory examination showed that the positive rate of anti-nuclear antibody was 94.7%, hypocomplement was 91.2%, anemia was 80.7, dsDNA positive was 75.4%, high IgG was 49.1%, electrolyte disorder was 45.63.The most common renal pathological classification was type 鈪

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