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目的了解小儿肾小球疾病肾脏病理改变的特点及其与临床表现的关系。方法对近20年间该院的1316例患儿的肾活检资料,进行了回顾性分析。结果1316例患儿中临床主要表现为肾病综合征(383例,占29.09%)、急性肾炎综合征(291例,占22.00%)、孤立性血尿(224例,占17.21%)、紫癜性肾炎(209例,占15.87%)、乙型肝炎病毒相关肾炎(96例,占7.30%)等。病理改变主要为系膜增生(756例,占57.45%)、IgA肾病(113例,占8.59%)、毛细血管内增生(112例,占8.51%)、膜性肾病(66例,占5.02%)、微小和轻微病变(59例,占4.48%)等。通过超微结构检查,使Alport综合征、薄基底膜病、先天性肾病、纤维样肾小球病、Fabry病等,得以明确诊断。通过肾活检组织免疫病理学检查,使IgA肾病、IgM肾病及C1q肾病得以确诊。肾活检患儿中原发性肾小球疾病最为常见(915例,占69.53%)。原发性肾小球疾病病因以原发性肾病综合征为最常见(375/915例,占41.0%),而继发性肾小球疾病病因以紫癜性肾炎为最常见(209/344例,占60.8%)。结论在该次调查的肾活检资料中,原发性肾小球疾病最常见,肾病综合征是最常见的临床诊断,病理改变则以系膜增生最为多见。
Objective To understand the characteristics of renal pathological changes in children with glomerular diseases and its relationship with clinical manifestations. Methods The data of 1316 children with renal biopsy in our hospital during the past 20 years were retrospectively analyzed. Results The main clinical manifestations in 1316 children were nephrotic syndrome (383 cases, accounting for 29.09%), acute nephritic syndrome (291 cases, accounting for 22.00%), isolated hematuria (224 cases, 17.21%), purpura nephritis (209 cases, accounting for 15.87%), hepatitis B virus associated nephritis (96 cases, accounting for 7.30%) and so on. The main pathological changes were mesangial hyperplasia (756 cases, accounting for 57.45%), IgA nephropathy (113 cases, 8.59%), intraepithelial capillary hyperplasia (112 cases, accounting for 8.51%), membranous nephropathy ), Minor and minor lesions (59 cases, 4.48%) and so on. Through the ultrastructural examination, Alport syndrome, thin basement membrane disease, congenital nephropathy, fibro-glomerular disease, Fabry disease, to confirm the diagnosis. IgA nephropathy, IgM nephropathy and C1q nephropathy were confirmed by immunopathological examination of renal biopsy tissue. Primary renal glomerular disease in children with renal biopsy is the most common (915 cases, accounting for 69.53%). The etiology of primary glomerular disease is the most common in primary nephrotic syndrome (375/915 cases, 41.0%), while the cause of secondary glomerular disease is purpura nephritis, the most common (209/344 cases , Accounting for 60.8%). Conclusion In this survey, primary glomerular disease is most common in renal biopsy data. Nephrotic syndrome is the most common clinical diagnosis, while mesangial proliferation is the most common pathological change.