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目的探讨儿童过敏性紫癜性肾炎(HSPN)免疫病理类型与其临床、病理的相关性。方法对2003年2月-2008年12月本院行肾组织活检的62例HSPN患儿的临床分型、病理分级、免疫病理分型进行回顾性分析;根据免疫荧光检查结果,将免疫病理分为5型,并分析不同免疫病理分型的HSPN患儿在临床分型、病理分级上的分布特点。结果临床分型以血尿和蛋白尿型最多见(37.09%);病理分级以Ⅲb级最多见(45.16%);免疫病理分型以IgA加IgG加IgM沉积型最多(37.09%)。不同免疫病理类型的HSPN在临床分型分布上差异无统计学意义(P>0.05);而IgA加IgG加IgM沉积型与其他免疫病理类型在病理分级上比较,其表现为Ⅲb～Ⅵ级的比例较高(P<0.05),有IgM沉积者(IgA加IgM沉积型和IgA加IgG加IgM沉积型)与无IgM沉积者(单纯IgA沉积型及IgA加IgG沉积型)在病理分级上比较,前者表现为Ⅲb～Ⅵ级的比例较高(P<0.05);伴C3沉积的病例Ⅲb～Ⅵ级的比例较无伴C3沉积者高(P<0.05)。结论HSPN的免疫病理类型与临床分型之间无相关性,与其病理分级之间有一定的联系。
Objective To investigate the correlation between the immunopathological types of children with HSPN and their clinical and pathological features. Methods The clinical classification, pathological grading and immunopathologic classification of 62 cases of HSPN in our hospital from February 2003 to December 2008 were retrospectively analyzed. According to the results of immunofluorescence, immunopathological score For type 5, and analysis of different immunopathological types of HSPN children in the clinical classification, pathological grading distribution. Results The most common type was hematuria and proteinuria (37.09%) in clinical classification. The highest grade was grade Ⅲb (45.16%) in pathological classification. IgA plus IgG plus IgM deposition type was the highest (37.09%) in immunopathological classification. There was no significant difference in the distribution of HSPN among the different immunopathological types (P> 0.05). IgA plus IgG plus IgM and other immunopathological types were compared in pathological grade, which showed that grade Ⅲb to Ⅵ (P <0.05). The pathological grading of IgM (IgA plus IgM plus IgA plus IgG plus IgM) versus non IgM (IgA plus IgA plus IgG) , While the former showed a higher proportion of Ⅲb-Ⅵ (P <0.05). The percentage of Ⅲb-Ⅵ of patients with C3 deposition was higher than those without C3 deposition (P <0.05). Conclusion There is no correlation between the immunopathological types and clinical classification of HSPN, and there is a certain relationship between the immunopathological features and the pathological grade of HSPN.