儿童IgA肾病的临床与病理分析.pdf

《儿童IgA肾病的临床与病理分析.pdf》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、·534·临床肾脏病杂志2014年9月第14卷第9期JClinNephrol，September2014，Vb1．14，No．9·论著·儿童IgA肾病的临床与病理分析赵丽萍周红霞葛婷婷张林徐锦雯【摘要】目的探讨IgA。肾病患儿临床表现和病理改变的关系及疾病转归。方法分析3O例IgA肾病患儿的临床和病理改变，病理分型采用改良Lee分型法，其中28例进行随访，4例重复肾活检。结果临床表现孤立性血尿型1O例，病理为I、Ⅱ级；血尿和蛋白尿型11例，病理为I～Ⅲ级；急性肾炎型2例，病理Ⅲ级；肾病综合征型7例，病理为Ⅱ～Ⅳ级，以Ⅱ、Ⅲ级为主。

2、4例行重复肾活检，病理变化为改善、加重和无明显变化，但免疫复合物沉积均有加重。28例随访1年2个月～9年，其中9例预后不乐观；死亡1例；预后不良患儿7例治疗依从性差。结论IgA肾病临床表现与病理有一定相关性，急性肾炎型、肾病综合征型患儿损伤重、预后欠佳，同时提示临床医师重视IgA肾病患儿随访和健康宣教，提高治疗依从性，以利疾病康复。【关键词】IgA肾病；病理；儿童ClincopathologicfeaturesofIgAnephropathyinchildrenZHAOLi—ping，ZH0UHong-xia，GETing-tin

3、g，ZHANGLin，XUJin—wen．DepartmentofNephrology，WuxiChildren’SHospital，W214023．Cina[Abstract]ObjectiveTostudythec1inicopathologicfeaturesandprognosisofchildrenwithIgAnephropathy．MethodsWeanalyzedthec1inicopatho10gicdataof30IgAnephropathycasesclassifiedbyimprovedLeepatholo

4、gicaltyping．Twenty-eightcaseswerefollowedup，and4casesacceptedrenalbiopsyrepeatedly．ResultsTherewere10casesofisolatedhematuriawithpathologicgrades工andⅡ．ElevencaseshadhematuriaandproteinuriawithpathologicgradesfromItoII．Twocasesshowedacutenephritiswithpathologicgradesfr

5、omItOII．SevencasesshowednephroticsyndromwithpathologicgradesfromItoIV．Amongallthecases，gradesⅡandI1wereinmajoritywithpro—portionof66．7．Fourcaseswerebiopsiedrepestedly，andthepathologicchangesshowedimprove—ment，exacerbationornochange，butimmunoglobulindepositionwasincrea

6、sedinthesecases．Wehadfollowedup28casesfromoneyear2monthtO9years．Ninecaseshadbadprognosis，inwhich1casedied，and7caseshadpoortreatmentadherence．ConclusionsIgAnephropathypatientsweremainlyinschoolchildren，inwhichboysweremorethangirls．Clinicalmanifestationshowedrelationswi

7、thpa—thologytOsomeextent．ThepathologicdamageofisolatedhematuriainIgAnephropathyhadbetterprognosisrelatively．Inthepatientswithpathologicchangesofacutenephritis，thedamagewasmoreserious，andprognosiswasworse．Soweshouldpaymoreattentiontothefollow-upofthechildrenwithIgAneph

8、ropathy．WeshouldguidethemtOhaveproperdietandtOpreventagainstinfection．Alsoweshouldmonitorsideeffectsofpharmaceuticaldrugsand