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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (2): 110-113.DOI: 10.3969/j.issn.1673-5501.2023.02.006

• 论著 • 上一篇    下一篇

紫癜性肾炎患儿肾脏活检新月体比例与临床和病理特征的病例系列报告

宋纯东1,2,6,宋丹3,6,田金芝4,徐虹5,杨晓青1,2,张博1,2,丁樱1,2,任献青1,2,翟文生1,2   

  1. 1 河南中医药大学第一附属医院郑州，450000；2 河南中医药大学儿科医学院郑州，450000；3 河南中医药大学郑州，450046；4 河南信阳中心医院信阳，464000；5 复旦大学附属儿科医院上海，201102；6 共同第一作者
  • 收稿日期:2021-12-06 修回日期:2023-03-16 出版日期:2023-04-25 发布日期:2023-05-19
  • 通讯作者: 田金芝

Proportion of crescent bodies in renal biopsy and clinicopathological features in children with HenochSchnlein purpura nephritis: A case series report

SONG Chundong1,2,6, SONG Dan3,6, TIAN Jinzhi4, XU Hong5, YANG Xiaoqing1,2, ZHANG Bo1,2, DING Ying1,2, REN Xianqing1,2, ZHAI Wensheng1,2   

  1. 1 The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450000, China; 2 School of Pediatrics, Henan University of Traditional Chinese Medicine, Zhengzhou 450000, China; 3 Henan University of Chinese Medicine, Zhengzhou 450046, China; 4 Henan Xinyang Central Hospital, Xinyang 464000, China; 5 Children's Hospital Affiliated to Fudan University, Shanghai 201102, China; 6 Co-first author
  • Received:2021-12-06 Revised:2023-03-16 Online:2023-04-25 Published:2023-05-19
  • Contact: TIAN Jinzhi，email：tjz92089208@126.com

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摘要： 背景：新月体是紫癜性肾炎（HSPN）患者常见的病理特征，但目前关于新月体比例与HSPN患儿临床和病理特征的相关性报道较少。 目的：比较不同新月体比例HSPN患儿的临床和病理特征。 设计：病例系列报告。 方法：纳入2013年1月至2017年12月在河南中医药大学第一附属医院儿科肾病中心确诊HSPN、行首次肾活检且新月体比例≤50%的住院患儿。根据肾活检病理报告中的新月体比例分为无新月体组、新月体<25%组和新月体~50%组。从病历中截取患儿的一般情况、临床表现、肾活检前实验室检查指标和肾活检病理报告，并进行组间比较。 主要结局指标：新月体比例与临床表现、肾脏病理特征的关系。 结果：416例HSPN患儿进入本文分析，其中无新月体组167例，新月体<25%组222例，新月体~50%组27例。①临床表现：水肿的发生率新月体<25%组和新月体~50%组高于无新月体组，差异均无统计学意义，3组临床分型均以血尿加蛋白尿型为主，肾病综合征型占比新月体~50%组高于其他2组，差异均有统计学意义。②实验室检查指标：新月体~50%组24 h尿蛋白定量、BUN水平均高于其他2组，肾小球滤过率低于其他2组；新月体<25%组和新月体~50%组的CRP、D二聚体水平均高于无新月体组；新月体~50%组血清肌酐高于无新月体组；差异均有统计学意义。③肾小球病理中，新月体<25%组和新月体~50%组纤维素样坏死、内皮细胞增生比例均高于无新月体组；随着新月体比例增加，肾小管间质病理分级为+级的比例逐渐增加，C3、FIB沉积程度为++级的比例逐渐增加，差异均有统计学意义；新月体比例与肾小管间质病理分级程度呈低度正相关（r=0.308，P＜0.001），与C3沉积程度（r=0.139，P=0.005）和FIB沉积程度（r=0.177，P＜0.001）呈微弱正相关。 结论：新月体比例与HSPN患儿肾小球病理、肾小管间质损伤、C3和FIB沉积、临床分型的严重性均存在一定平行关系。

关键词: 新月体, 紫癜性肾炎, 临床表现, 肾脏病理

Abstract: Background： Crescents are a common pathological feature in patients with purpura nephritis (HSPN), but there are few reports on the correlation between the proportion of crescents and the clinical and pathological features of children with HSPN. Objective：To compare the clinical and pathological features of HSPN children with different crescentic ratios. Design：Case series report. Methods：The hospitalized children were enrolled between January 2013 to December 2017 at the Pediatric Nephrology Center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine where they were diagnosed with HSPN and underwent the first renal biopsy with a crescent ratio ≤ 50%. According to the crescent proportion in the pathological report of renal biopsy, patients were divided into no crescent group, crescent <25% group and crescent 25% to 50% group. The general information, clinical manifestations, laboratory test indicators before renal biopsy, and pathological report of the renal biopsy were intercepted from the medical records, and compared between groups. Main outcome measures：The relationship between crescent ratio and clinical manifestations and renal pathological features. Results：A total of 416 children with HSPN were included in the analysis, including 167 cases in the no crescent group, 222 cases in the crescent <25% group, and 27 cases in the crescent 25% to 50% group. For clinical manifestations, the incidence of edema in the crescent <25% group and the crescent 25% to 50% group was higher than that in the no crescent group. Hematuria plus proteinuria was the main clinical type in the three groups. The proportion of nephrotic syndrome in the crescent 25% to 50% group was higher than that in the other two groups, and the differences were statistically significant. For laboratory examination indicators, the 24h urine protein quantification and BUN level in the crescent 25% to 50% group were higher than those in the other two groups, and the eGFR was lower than that in the other two groups. The levels of CRP and Ddimer in the crescent <25% group and the crescent 25% to 50% group were higher than those in the no crescent group. Scr in the crescent 25% to 50% group was higher than that in the no crescent group. The differences were statistically significant. According to the glomerular pathology, the proportions of fibrinoid necrosis and endothelial cell hyperplasia in the crescent <25% and 25% to 50% groups were higher than those in the no crescent group. The proportion of interstitial pathology graded as + and the proportion of C3 and fibrinogen (FIB) graded as ++ gradually increased with the growing crescent ratio. The differences were statistically significant. There is a positive correlation between the crescent proportion and the degree of renal tubular interstitial pathological grade (r=0.308, P<0.001), and a weak positive correlation with the degree of C3 deposition (r=0.139, P=0.005) and the degree of FIB deposition (r=0.177, P<0.001). Conclusions：There is a parallel relationship between the crescent proportion and the severity of glomerular pathology, tubular interstitial injury, C3 and FIB deposition, and clinical staging in HSPN children.

Key words: Crescentic bodies, Purpura nephritis, Clinical manifestation, Renal pathology

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