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1、IgA腎病與過(guò)敏性紫癜性腎炎的臨床和病理對(duì)比分析作者：周長(zhǎng)華蔡林祥朱月文居建析徐宏【摘要】目的對(duì)比研究有新月體形成（<50%）的IgAN腎病(IgAN)和過(guò)敏性紫癜性腎炎(HSPN)在臨床及腎臟病理改變上的異同，探討兩者的關(guān)系。方法對(duì)經(jīng)腎活檢證實(shí)的病理上有<50%新月體形成的25例IgAN及23例HSPN成人（>18歲）進(jìn)行臨床及病理對(duì)比分析。結(jié)果IgAN和HSPN臨床表現(xiàn)相似，高血壓、血尿、蛋白尿、尿NAG酶升高等發(fā)生率差異均無(wú)顯著性（P>0.05）；IgAN腎功能損害程度較重，兩者的血肌酐水平差異有顯著性（
2、P<0.05）；IgAN和HSPN腎臟的組織病理檢查，節(jié)段新月體形成率和球囊粘連、內(nèi)皮增生、節(jié)段硬化等發(fā)生率差異均無(wú)顯著性（P>0.05），而袢壞死、球性硬化、腎間質(zhì)纖維化、腎小管萎縮發(fā)生率差異均有顯著性（P<0.05）；兩組免疫病理均以IgA在系膜區(qū)沉積為主（伴或不伴血管袢的沉積），沉積差異無(wú)顯著性（P>0.05）。結(jié)論IgAN與HSPN兩者在高血壓、血尿、蛋白尿發(fā)生率等臨床表現(xiàn)差異無(wú)顯著性，但I(xiàn)gAN腎功能減退明顯，腎組織發(fā)生球性硬化、間質(zhì)纖維化、小管萎縮等慢性化病變較重?！娟P(guān)鍵詞】IgA腎病過(guò)敏性紫癜性腎
3、炎新月體臨床和病理 【Abstract】ObjectiveTocomparetheclinicalandpathologicalcharactersisticsinpatientswithcrescentic(<50%)IgAnephropathy(IgAN)andHenoch-Schonleinpurpuranephritis(HSPN).Thepresentstudyaimedtocharacterizetheirrelationshipthroughclinicopathologicalcomparisonbetween
4、IgANandHSPN.Methods25adultwithIgANand23adultwithHSPNinthisstudy.Theirclinicalmanifestations,bloodbiochemicaltest,renalpathologicalfindingsinlightmicroscopyandimmunofluorescencewereanalyzedandalsocomparedbetween25IgANand23HSPN.ResultTheclinicalpatternsofIgANandHSPNweresi
5、milar.Hypertension/hematuria(severeandmirror)/proteinuriaandurineNAGenzymaticarisingwerenotsignificant(P>0.05).ButinIgAN,renalfunctionwasdamagedbadlyandtheserumcreatininewassignificantlyhigherthanthatinHSPN(P<0.05).Pathologicalexamination,suchassegmentalcrescents/
6、glomeruli-Bowman'scapsuleadhesion/endothelialproliferationandsegmentsclerosiswerefoundsimilarlyinIgANandHSPNpatients(P>0.05).Whiletheglobalsclerosis/renalinterstitialfibrosisandtubularatrophyweremarkedlyhigherinIgANthanthatinHSPNpatients(P<0.05).Capillarynecrosisw
7、aslowerinIgANthaninHSPNpatients(P<0.05).AllthecasesinbothgroupshadIgA5depositioninglomerulus.Nosignificantdifferencewasfoundthedepositionsof,IgG,IgM.C3,C4andC1qonglomerulusbetweentwogroups(P>0.05).ConclusionsTheclinicalpatternsofIgAnephropathyandHSPNweresimilar.Wh
8、ilethepathologicalchangessuchasrenaldysfunction,globalsclerosis,renalinterstitiumfibrosisandtubularatrophywere
