摘要
目的探讨过敏性紫癜性肾炎(HSPN)肾小球内纤维蛋白原(Fib)沉积的意义。方法回顾分析行肾活检的82例HSPN患儿的临床和病理资料。HSPN患儿按肾脏免疫病理是否有肾小球内Fib沉积及沉积强度分组,比较各组患儿的临床和病理特征。结果 82例患儿中63例有肾小球内Fib沉积,发生率为76.83%,其中Fib+23例(28.05%),Fib++37例(45.12%),Fib+++3例(3.66%),肾小管未发现有沉积。超敏C反应蛋白(hs-CRP)、D二聚体(DD)、CD 19^+CD 23^+淋巴细胞亚群及尿微量白蛋白与肌酐比值(UMA/Cr)在无沉积组、轻度沉积组及重度沉积组间比较,差异有统计学意义(P<0.01)。重度沉积组的hs-CRP和CD19^+CD 23^+水平高于轻度沉积组和无沉积组,差异有统计学意义(P<0.05);重度和轻度沉积组的DD水平高于无沉积组,差异有统计学意义(P<0.05);重度沉积组的UMA/Cr高于无沉积组,差异有统计学意义(P<0.05)。肾小球Fib沉积与Ig A沉积呈正相关(r=0.64,P<0.001);三组患儿肾小球Ig G沉积比例差异有统计学意义(P<0.05),重度沉积组的Ig G沉积比例较高。结论有肾小球Fib沉积的患儿,尤其Fib沉积严重者免疫功能紊乱,炎症反应及高凝状态更严重,肾功能损害也可能更严重。
Objective To explore the significance of glomerular fibrinogen(Fib)deposition in Henoch-Sch?nlein purpura nephritis(HSPN).Methods The clinical and pathological data of82children with HSPN diagnosed by renal biopsy were retrospectively analyzed.The clinical and pathological characteristics of each group were compared according to whether there were glomerular Fib deposition and deposition intensity in the kidney.Results Glomerular Fib deposition was observed in63cases(76.83%)in82cases,including Fib+23cases(28.05%),Fib++37cases(45.12%)and Fib+++3cases(3.66%),and no deposition had been found in renal tubules.The levels of high sensitivity C reactive protein(hs-CRP),D-Dimer(DD),CD19+CD23+lymphocyte subsets,and urinary albumin to creatinine ratio(UMA/Cr)were significantly different among nondeposition group,mild deposition group and severe deposition group(P<0.01).The levels of hs-CRP and CD19+CD23+in severe deposition groups were significantly higher than those in the mild and non-deposition groups(P<0.05).The level of D-D in the severe and mild deposition group was significantly higher than that in the non-deposition group(P<0.05).The UMA/Cr in the severe deposition group was significantly higher than that in the non-deposition group(P<0.05).Glomerular Fib deposition is positively correlated with IgA deposition(r=0.64,P<0.001).The proportion of glomerular IgG deposition among three groups was significantly different(P<0.05),and the proportion of IgG deposition in the severe group was the highest.Conclusions When children had glomerular Fib deposition,especially in the case of severe Fib deposition and immune dysfunction,inflammatory response and hypercoagulability are more serious and renal function damage may be more serious.
作者
王凤英
李晓忠
王兴东
朱雪明
WANG Fengying;LI Xiaozhong;WANG Xingdong;ZHU Xueming(Department of Nephrology and Rheumatology ,Suzhou 21500,Jiangsu,China;Department of Pathology,Children's Hospital of Soochow University,Suzhou 21500, Jiangsu,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2018年第3期182-187,共6页
Journal of Clinical Pediatrics
基金
国家自然基金资助项目(No.81370787)
江苏省临床医学科技专项(No.BL2014052)
关键词
纤维蛋白原沉积
过敏性紫癜性肾炎
儿童
fibrinogen deposition
Henoch-Schonlein purpura nephritis
child
