胡云霞，胡小涵，张玉桦，何晓青，陈丽虹，杨青，林益怡，庄捷秋

    (温州医科大学附属第二医院育英儿童医院，浙江 温州 325027，1.儿童肾内科；2.儿童超声科)

    伴肾小管间质损害的儿童紫癜性肾炎临床病理及预后分析

    胡云霞1，胡小涵1，张玉桦1，何晓青1，陈丽虹1，杨青1，林益怡2，庄捷秋1

    (温州医科大学附属第二医院育英儿童医院，浙江 温州 325027，1.儿童肾内科；2.儿童超声科)

    目的：探讨伴肾小管间质损害的儿童紫癜性肾炎(HSPN)的临床、病理及预后情况。方法：回顾性分析2005年1月至2013年12月温州医科大学附属第二医院育英儿童医院收治的确诊为HSPN并行肾活检的93例患儿资料，根据肾小管间质损害程度进行分组，分析其临床、肾脏病理以及预后特点。结果：根据肾小管-间质病理分级结果将93例患儿分为无肾小管-间质损害组(1组，16例，占17.2%)、轻度肾小管-间质损害组(2组，66例，占71.0%)、中重度肾小管-间质损害组(3组，11例，占11.8%)。3组血肌酐高于1组(P<0.05)，内生肌酐清除率(Ccr)低于1组和2组(P<0.05)。3组系膜基质评分高于1组(P<0.05)，球囊粘连评分、纤维性新月体评分、肾小球硬化评分高于1组和2组(P<0.05)。多因素回归分析结果显示，球囊粘连是HSPN患儿肾小管间质损害的危险因素。随访86例，83例(占96.5%)临床恢复正常或有轻度尿异常，3例(占3.5%)进展为肾功能不全，3组预后差于2组(P<0.05)。结论：HSPN患儿可伴随肾小管-间质损害，但大部分较轻；肾小管-间质损害无敏感的临床检测指标，需尽早肾活检明确；肾小管-间质损害严重者，常早期出现肾功能受损，且肾小球病理如系膜基质增多、球囊粘连、纤维性新月体形成、肾小球硬化等病变明显，预后不良的可能性更大。

    儿童；紫癜性肾炎；肾小管-间质损害；临床病理；预后

    Abstract: Objective:To investigate the clinicopathological characteristics and prognosis in childhood Henoch-Sch?nlein purpura nephritis (HSPN) with or without tubulointerstitial lesions.Methods:The clinical and pathological data from 93 children with biopsy-proved HSPN were collected retrospectively in the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University from January 2005 to December 2013. The patients were grouped according to the degree of tubulointerstitial lesions, and relationship between their clinical, glomerular parameters, prognosis and tubulointerstitial lesions was analyzed.Results:Ninety-three cases were divided into 3 groups according to the degree of tubulointerstitial lesions, group 1 with no tubulointerstitial lesions (16 cases, 17.2%), group 2 with mild tubulointerstitial lesions (66 cases, 71.0%), and group 3 with severe tubulointerstitial lesions (11 cases, 11.8%). The serum creatinine level (P<0.05) and the mesangial matrix score (P<0.05) was significantly higher in group 3 than that in group 1, and creatinine clearance rates of group 3 was significantly lower than that in group 1 and group 2 (P<0.05). The balloon adhesion score, fibrous crescents score and glomerulosclerosis score of group 3 were significantly higher than that in group 1 and group 2 (P<0.05). Multivariate logistic regression analysis showed that the balloon adhesion was risk factor of tubulointerstitial lesions. In 86 cases with follow-up, 96.5% had clinical normal or mild abnormal urine, 3.5% developedto renal dysfunction, the prognosis of group 3 was significantly worse than that in group 2 (P<0.05). Conclusion:Some HSPN patients may present with tubulointerstitial lesions in pathology at early stage of disease, which is reliable indicator for patients to develop severe glomerular lesion, and the patients with poor prognosis in future. ......