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目的探讨儿童紫癜性肾炎(Henoch-Schnlein purpura nephritis,HSPN)足突融合与肾脏病理分级的相关性。方法回顾性分析2008年1月1日至2011年1月1日南京军区南京总医院儿科肾活检病理检查诊断为过敏性紫癜性肾炎的住院病例72例,对其进行病理分级和免疫荧光分型,并在电镜下观察足细胞足突融合情况。结果病理分级按照国际儿童肾脏病学会(ISKDC)分类集中在Ⅱ级和Ⅲ级,其中病理分级为Ⅱ级的患儿34例(47.2%),病理分级为Ⅲ级38例(52.8%)。电镜下观察肾小球足细胞损伤情况:足突广泛融合21例,足突节段融合35例和无足突融合11例;5例电镜下未见肾小球。足突广泛融合患儿病理分级为Ⅲ级者较足突节段融合、无足突融合者多。足突广泛融合患儿中免疫荧光分型以IgA+IgM+IgG型最多;足突节段融合患儿中免疫荧光分型以IgA+IgG型较多,无足突融合患儿中免疫荧光分型以单纯IgA型最多。结论儿童HSPN的肾小球病理改变除了系膜细胞的增生外,还存在足细胞损伤的情况,足细胞损伤情况越重病理改变越明显。
Objective To investigate the relationship between foot process fusion and pathological grading of Henoch-Schnlein purpura nephritis (HSPN) in children. Methods A retrospective analysis of 72 hospitalized cases of Henoch-Schonlein purpura nephritis diagnosed by pathological examination of pediatric renal biopsy in Nanjing General Hospital of Nanjing Military Command from January 1, 2008 to January 1, 2011 was performed. The pathological grading and immunofluorescence typing , And observe the fusion of podocyte foot process under the electron microscope. Results The pathological grade was classified into grade Ⅱ and grade Ⅲ according to the International Society of Pediatric Nephrology (ISKDC). Among them, 34 (47.2%) were pathologically grade Ⅱ and 38 (52.8%) were grade Ⅲ. Electron microscopy of glomerular podocyte injury: foot process extensive fusion in 21 cases, foot process segment fusion in 35 cases and no foot process fusion in 11 cases; 5 cases under the electron microscope, no glomerular. Foot process of children with a wide range of pathological grading Ⅲ grade than the foot process segment fusion, no foot sudden fusion of many. IgA + IgM + IgG types were the most common types of immunofluorescence in children with fusion of foot processes. Immunofluorescence typing in children with fusion of foot processes was characterized by more IgA + IgG types and no immunofluorescence Type of simple IgA type up. Conclusion In addition to the mesangial cell hyperplasia, the pathological changes of glomeruli in children with HSPN also exist podocyte injury. The more podocyte injury is, the more obvious the pathological changes are.