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1、·534·臨床腎臟病雜志2014年9月第14卷第9期JClinNephrol，September2014，Vb1．14，No．9·論著·兒童IgA腎病的臨床與病理分析趙麗萍周紅霞葛婷婷張林徐錦雯【摘要】目的探討IgA。腎病患兒臨床表現(xiàn)和病理改變的關(guān)系及疾病轉(zhuǎn)歸。方法分析3O例IgA腎病患兒的臨床和病理改變，病理分型采用改良Lee分型法，其中28例進行隨訪，4例重復腎活檢。結(jié)果臨床表現(xiàn)孤立性血尿型1O例，病理為I、Ⅱ級；血尿和蛋白尿型11例，病理為I～Ⅲ級；急性腎炎型2例，病理Ⅲ級；腎病綜合征型7例，病理為Ⅱ～Ⅳ級，以Ⅱ、Ⅲ級為主。
2、4例行重復腎活檢，病理變化為改善、加重和無明顯變化，但免疫復合物沉積均有加重。28例隨訪1年2個月～9年，其中9例預后不樂觀；死亡1例；預后不良患兒7例治療依從性差。結(jié)論IgA腎病臨床表現(xiàn)與病理有一定相關(guān)性，急性腎炎型、腎病綜合征型患兒損傷重、預后欠佳，同時提示臨床醫(yī)師重視IgA腎病患兒隨訪和健康宣教，提高治療依從性，以利疾病康復。【關(guān)鍵詞】IgA腎??；病理；兒童ClincopathologicfeaturesofIgAnephropathyinchildrenZHAOLi—ping，ZH0UHong-xia，GETing-tin
3、g，ZHANGLin，XUJin—wen．DepartmentofNephrology，WuxiChildren’SHospital，W214023．Cina[Abstract]ObjectiveTostudythec1inicopathologicfeaturesandprognosisofchildrenwithIgAnephropathy．MethodsWeanalyzedthec1inicopatho10gicdataof30IgAnephropathycasesclassifiedbyimprovedLeepatholo
4、gicaltyping．Twenty-eightcaseswerefollowedup，and4casesacceptedrenalbiopsyrepeatedly．ResultsTherewere10casesofisolatedhematuriawithpathologicgrades工andⅡ．ElevencaseshadhematuriaandproteinuriawithpathologicgradesfromItoII．Twocasesshowedacutenephritiswithpathologicgradesfr
5、omItOII．SevencasesshowednephroticsyndromwithpathologicgradesfromItoIV．Amongallthecases，gradesⅡandI1wereinmajoritywithpro—portionof66．7．Fourcaseswerebiopsiedrepestedly，andthepathologicchangesshowedimprove—ment，exacerbationornochange，butimmunoglobulindepositionwasincrea
6、sedinthesecases．Wehadfollowedup28casesfromoneyear2monthtO9years．Ninecaseshadbadprognosis，inwhich1casedied，and7caseshadpoortreatmentadherence．ConclusionsIgAnephropathypatientsweremainlyinschoolchildren，inwhichboysweremorethangirls．Clinicalmanifestationshowedrelationswi
7、thpa—thologytOsomeextent．ThepathologicdamageofisolatedhematuriainIgAnephropathyhadbetterprognosisrelatively．Inthepatientswithpathologicchangesofacutenephritis，thedamagewasmoreserious，andprognosiswasworse．Soweshouldpaymoreattentiontothefollow-upofthechildrenwithIgAneph
8、ropathy．WeshouldguidethemtOhaveproperdietandtOpreventagainstinfection．Alsoweshouldmonitorsideeffectsofpharmaceuticaldrugsand
