不同年龄组紫癜性肾炎患者临床表现、病理分级及预后的比较

摘要

目的：比较不同年龄段紫癜性肾炎（HSPN）患者病理分级、临床分型及预后的差别。方法选取我院儿科及肾内科收治并诊断为HSPN的225例患者，对其临床表现、病理分级及预后进行回顾性分析，并比较不同年龄组患者在病理分级、临床分型及预后方面的差异。结果 HSPN伴随症状中消化道症状发生率各年龄组总体比较有差异，其中腹痛发生率学龄期最高，但关节症状发生率各年龄组无明显差异。HSPN临床表现中尿蛋白程度与病理分级呈正相关（r=0.471，P<0.0001）。不同年龄组病理分级的差异有统计学意义（H=19.194，P<0.0001），主要体现在成人期与学龄前期及青春期患者在病理分级上均有统计学差异（Z=-2.702，P=0.001；Z=-3.675，P<0.0001）。不同年龄组临床分型的差异有统计学意义（χ2=36.114，P<0.0001），其中成人期患者与学龄期及青春期患者临床表现均有统计学差异（χ2=19.628，P<0.0001；χ2=18.944，P<0.0001）。最终发展为慢性肾功能不全的儿童和成人病理分级无明显差异。结论儿童与成人相比病理分级及临床表现相对轻，预后良好，影响预后最主要的决定因素是病理分级，临床表现中尿蛋白在一定程度反映病理分级的轻重。%Objective To compare differences in pathological grade,clinical classification and prognosis in patients with Henoch⁃Schönlen purpu⁃ra nephritis(HSPN)in each age group. Methods Totally 225 cases of patients diagnosed as HSPN and treated in the hospital were selected to ret⁃rospectively analyze their clinical manifestations,pathological classification and prognosis and compare the difference in pathological grade,clinical classification and prognosis by age. Results Of the concomitant symptoms of HSPN,the incidence rate of abdominal pain was the highest in pa⁃tients of school age. There was statistical significance in the incidence rate of gastrointestinal bleeding between each age group. Of the clinical mani⁃festations,proteinuria was positive correlated with the pathological type,and the difference was statistically significant(r=0.471,P<0.000 1). But there was no correlation between the count of urine red blood cells in the urine and the pathological type. There was difference in the pathological grade between each age group(H=19.194,P<0.000 1). The difference mainly showed in the pathological grade between adults,children of pre⁃school age and adolescents(Z=-2.702,P=0.001;Z=-3.675,P<0.000 1). There was difference in clinical classification between each age group (χ2=36.114,P<0.000 1). The difference mainly showed in clinical manifestations between adults,children of school age and adolescents(χ2=19.628,P<0.000 1;χ2=18.944,P<0.000 1). For both children and adults who had developed into chronic renal failure,the renal pathology of these patients was not significantly different. Conclusion Compared with adults,children have milder pathological types and clinical manifestations and well prognosis of HSPN,and the most important factor which affects the prognosis is pathological type and urine protein can reflect the serious⁃ness of pathological type.