IgA肾病及过敏性紫癜性肾炎临床及病理对比分析.docVIP

IgA肾病及过敏性紫癜性肾炎临床及病理对比分析 　 作者：周长华 蔡林祥 朱月文 居建析 徐宏 【摘要】 目的 对比研究有新月体形成（lt;50%）的IgAN肾病(IgAN)和过敏性紫癜性肾炎(HSPN)在临床及肾脏病理改变上的异同，探讨两者的关系。 方法 对经肾活检证实的病理上有lt;50%新月体形成的25例IgAN及23例HSPN成人（gt;18岁）进行临床及病理对比分析。 结果 IgAN和HSPN临床表现相似，高血压、血尿、蛋白尿、尿NAG酶升高等发生率差异均无显著性（Pgt;0.05）；IgAN肾功能损害程度较重，两者的血肌酐水平差异有显著性（Plt;0.05）；IgAN和HSPN肾脏的组织病理检查，节段新月体形成率和球囊粘连、内皮增生、节段硬化等发生率差异均无显著性（Pgt;0.05），而袢坏死、球性硬化、肾间质纤维化、肾小管萎缩发生率差异均有显著性（Plt;0.05）；两组免疫病理均以IgA在系膜区沉积为主（伴或不伴血管袢的沉积），沉积差异无显著性（Pgt;0.05）。 结论 IgAN与HSPN两者在高血压、血尿、蛋白尿发生率等临床表现差异无显著性，但IgAN肾功能减退明显，肾组织发生球性硬化、间质纤维化、小管萎缩等慢性化病变较重。 【关键词】 IgA肾病 过敏性紫癜性肾炎 新月体 临床和病理 　　【Abstract】 Objective To compare the clinical and pathological charactersistics in patients with crescentic(lt;50%)IgA nephropathy(IgAN) and Henoch-Schonlein purpura nephritis(HSPN). The present study aimed to characterize their relationship through clinicopathological comparison between IgAN and HSPN. Methods 25 adult with IgAN and 23 adult with HSPN in this study. Their clinical manifestations,blood biochemical test , renal pathological findings in light microscopy and immunofluorescence were analyzed and also compared between 25 IgAN and 23 HSPN . Result The clinical patterns of IgAN and HSPN were similar. Hypertension/ hematuria(severe and mirror) / proteinuria and urine NAG enzymatic arising were not significant (Pgt;0.05).But in IgAN ,renal function was damaged badly and the serum creatinine was significantly higher than that in HSPN (Plt;0.05). Pathological examination ,such as segmental crescents /glomeruli-Bowman’s capsule adhesion /endothelial proliferation and segment sclerosis were found similarly in IgAN and HSPN patients(Pgt;0.05). While the global sclerosis /renal interstitial fibrosis and tubular atrophy were markedly higher in IgAN than that in HSPN patients(Plt;0.05).Capillary necrosis was lower in IgAN than in HSPN patients(Plt;0.05).All the cases in both groups had IgA deposition in glomerulus. No significant difference was found the depositions of, IgG,IgM.C3,C4 and C1q on glomerulus between