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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (1): 49-52.

• 论著 • 上一篇    下一篇

紫癜性肾炎患儿合并急性肾损伤危险因素的病例对照研究

应蓓，李宇红，邵晓珊，邱杰，郑莎莎，张晓婵，刘远辉，唐勇


  

  1. 贵阳市妇幼保健院肾脏科贵阳，550003
  • 收稿日期:2021-07-30 修回日期:2022-01-01 出版日期:2022-02-25 发布日期:2022-02-25
  • 通讯作者: 李宇红

Risk factors for acute kidney injury in children with Henoch-Schnlein purpura nephritis: A case-control study

YING Bei, LI Yuhong, SHAO Xiaoshan, QIU Jie, ZHENG Shasha, ZHANG Xiaochan, LIU Yuanhui, TANG Yong   

  1. Department of Nephrology ,Guiyang Maternity and Child Care Hospital, Guiyang 550003, China
  • Received:2021-07-30 Revised:2022-01-01 Online:2022-02-25 Published:2022-02-25
  • Contact: LI Yuhong，email:321735938@qq.com

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摘要： 背景：肾功能损害是紫癜性肾炎(HSPN)预后不良的危险因素，但目前关于HSPN伴急性肾损伤(AKI)患儿的临床和病理特征报道较少。 目的：探讨儿童HSPN合并AKI的病理特征及其危险因素。 设计：病例对照研究。 方法：纳入2016年1月至2020年12月贵州省贵阳市妇幼保健院经肾活检确诊的HSPN连续病例，根据是否合并AKI分为AKI组和非AKI组。从病历资料中截取患儿的人口学资料、临床症状、临床分型、入院当日实验室检查数据、24 h 血压、肾脏活检病理分级(包括ISKDC病理分型和牛津分类)和治疗等。 主要结局指标HSPN合并AKI的危险因素。 结果：181例HSPN患儿中,AKI组18例(10.0%)，非AKI组163例。两组性别、发病年龄、白蛋白水平、PLT计数差异均无统计学意义，AKI组肉眼血尿发生率和持续时间、24 h 尿蛋白定量、24 h 平均收缩压和舒张压均高于非AKI组，差异均有统计学意义。两组临床分型差异有统计学意义（χ2=8.942,P=0.003），AKI组以肾病综合征型和急性肾炎型为主，非AKI组以血尿+蛋白尿型、肾病综合征型为主。两组ISKDC分级差异有统计学意义（χ2=4.586,P=0.032），AKI组Ⅲ型及Ⅲ型以上比例高于非AKI组。牛津分类：AKI组肾小管间质病变(T1/T2)、新月体形成(C1/C2)比例高于非AKI组，差异有统计学意义（χ2分别为9.625和7.961，P分别为0.002和0.005）。Logistic回归分析显示，临床分型为急性肾炎型（OR=20.8，95%CI：1.37~317.79,P＜0.05）和牛津分类中的肾小管间质病变(OR=15.8，95%CI：2.17~15.65,P＜0.05)可能是HSPN患儿发生AKI的危险因素。AKI组18例治疗后，17例肾功能恢复正常，1例发展为慢性肾脏病。 结论：HSPN合并AKI临床及病理分型程度较重,临床分型为急性肾炎型、牛津分类提示肾小管间质病变可能是发生AKI的危险因素。

关键词: 紫癜性肾炎, 急性肾损伤, 临床表现, 肾脏病理, 儿童

Abstract: Background: Kidney injury is one of the risk factors for poor prognosis of HenochSchnlein purpura nephritis(HSPN) , however, there were few researches about the clinical and pathological features of HSPN with acute kidney injury (AKI). Objective: To investigate the pathological features and risk factors for HSPN complicated with AKI in children. Design: Casecontrol study. Methods: Consecutive cases of HSPN diagnosed by kidney biopsy from January 2016 to December 2020 in Guiyang Maternity and Child Care Hospital were included. According to whether AKI was combined or not, the children were divided into the AKI group and the nonAKI group. Demographic data, clinical symptoms, clinical classification, laboratory examination on the day of admission, 24hour blood pressure, pathological grade of kidney biopsy (including classification of ISKDC pathology and Oxford classification) and treatment were extracted from the medical records. Main outcome measures: The risk factors for HSPN with AKI. Results: Among 181 cases diagnosed with HSPN, there were 18 cases(10.0%) complicated with AKI, and 163 cases without AKI. The differences in sex, age of onset, albumin levels and PLT counts between the two groups of children were not statistically significant. The incidence of gross hematuria, the duration of gross hematuria, the level of 24hour urine protein, the level of 24hour creatinine and ambulatory blood pressure in the AKI group were higher than those of children in the nonAKI group, and the differences were statistically significant. The clinical classification difference was statistically significant between the two groups(χ2=8.942,P=0.003).The main clinical classification of AKI group was acute nephritis and nephrotic syndrome, while for nonAKI group it was hematuria and proteinuria type and nephrotic syndrome type. ISKDC classification difference was statistically significant between the two groups(χ2=4.586,P=0.032) that the proportion of type Ⅲ and above was higher in AKI group. According to the Oxford typing score,the proportion of tubular/interstital lesions (T1/T2) and crescent (C1/C2) in AKI group was higher than those in the nonAKI group, and the differences were statistically significant(χ2 was 9.625 and 7.961,P Value was 0.002 and 0.005). Logistic regression showed that acute nephritis in clinical classification, and the tubular stromal lesions in the Oxford classification were two risk factors for AKI in children with HSPN. After treatment, 17 cases in AKI group achieved normal renal function, and one case developed chronic kidney disease. Conclusion: HSPN with AKI is featured by severe clinical and pathologic classifications. Acute nephritis by clinical classification and tubulointerstitial lesions by Oxford typing score were the two risk factors for AKI in children with HSPN.

Key words: Henoch schonlein purpura nephritis, Acute kidney injury, Clinical manifestation, Renal pathology, Children