摘要
目的探讨儿童毛细血管内增生性肾小球肾炎（EPGN）的临床表现、病理特点、治疗方法及预后，为儿童EPGN的治疗提供参考。方法收集2007年1月至2011年5月于中国医科大学附属盛京医院小儿肾脏风湿免疫科住院期间经肾活检确诊为EPGN患儿45例临床资料。发病年龄3—14岁（男26例，女19例），对其临床、病理表现、治疗方法、预后进行回顾性分析。结果45例EPGN患儿中，临床表现为急性肾小球肾炎28例（62．2％），肾病综合征5例（11．1％），紫癜性肾炎3例（6．7％），急性肾小球肾炎伴急性肾功能不全6例（13.3％），肾病综合征伴急性肾功能不全2例（4．4％），紫癜性肾炎伴急性肾功能不全1例（2．2％），病理表现以肾病综合征（肾炎型）、感染后肾炎（肾病型）以及急性肾功能不全为重，有不同程度新月体形成及肾小球硬化。免疫荧光显示以IgG和C3沉积为主。对7例急性肾小球肾炎患者给予对症治疗，对伴有大量蛋白尿、紫癜性肾炎、急性肾功能不全的患者给予激素治疗，部分加用免疫抑制剂，均完全缓解。结论儿童EPGN临床上表现多样。对伴有大量蛋白尿和肾病综合征表现的患者给予激素，部分患者加用免疫抑制剂，取得较好疗效，长期预后尚须进一步观察。
Objective To investigate the clinical and pathologic features, the way of treatment and prognosis of endocap- illary proliferative glomerulonephritis （EPGN）, and to provide reference to the treatment of children with EPGN. Meth- ods The clinical and pathologic features, treatment and prognosis were studied by retrospective statistical analysis of 45 patients who were diagnosed with endocapillary proliferative glomerulonephritis by tachy-percutaneous renal biopsy, aged from 3 to 14 years old. Results The clinical manifestations of 45 patients with EPGN consisted of post-infectious glomemlonephritis （62.2%, 28/45 ）, nephrotic syndrome （ 11.1%, 5/45 ）, purpura nephritis （6.6%, 3/45 ）, acute post-infec- tious glomerulonephritis complicated with acute renal insufficiency（ 13.3%, 6/45）, nephrotic syndrome complicated with acute renal insufficiency （4.4%, 2/45）, and purpura nephritis complicated with acute renal insufficiency （2.2, 1~45）.Both nephrotic syndrome （nephritic type） and post-infectious glomerulonephritis （nephrotic type） were more serious in patholo- gy and complicated with crescent formation and glomerular sclerosis in different degree.IgG and C3 deposition could be seen in immunofluorescence. Seven patients with post-infectious glomerulonephritis were given symptomatic treatment; patients with proteinuria, purpuric nephritis or acute renal failure were giqen glucocorticoid or immunosuppression, and all had complete release. Conclusion The manifestation of children＇ s endocapillary proliferative glomerulonephritis is multiple.Renal biopsy can identify the pathologic type and help to direct the treatment and prognosis.Patients complicat- ed with quantitied proteinuria and nephrotic syndrome can given be glucocorticoid or immunosuppression and good effect is achieved, but prognosis needs further observation.
出处
《中国实用儿科杂志》
CSCD
北大核心
2013年第8期610-613,共4页
Chinese Journal of Practical Pediatrics
关键词
毛细血管内增生性肾小球肾炎
感染后肾炎
急性肾功能不全
肾活检
儿童
endocapillary proliferative glomerulonephritis
post-infectious glomerulonephritis
acute renal insufficiency
renal biopsy
child
