临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (12): 895-902.doi: 10.12372/jcp.2023.23e0697
聂晓晶, 陈伊
收稿日期:
2023-07-31
出版日期:
2023-12-15
发布日期:
2023-12-04
作者简介:
聂晓晶,联勤保障部队第九○○医院儿科(全军儿科疾病诊治中心)科主任,副主任医师,医学博士,博士后,兼职教授,美国俄亥俄州立大学访问学者。兼任中华医学会儿科学分会青年委员、全军儿科学专业委员会青年委员、福建省医学会儿科学分会副主任委员。《中华儿科杂志》、《临床儿科杂志》通讯/青年编委;福建省卫生健康医学科技专家库、福州市医保基金监管专家库专家。荣立个人三等功2次,获军队优秀专业技术人才岗位津贴。被评为原第二军医大学“A级教员”、福建医科大学“最美教师”和“优秀教师”。承担国家自然科学基金、福建省引导性重点项目、福建省自然科学基金等课题9项。在SCI收录期刊和核心期刊发表论著30余篇。临床救治案例入选《中国临床案例成果数据库》。获福建省科学技术奖三等奖1项、发明专利3项。参与编写Causes and Diagnosis of Autoimmune Diseases、《军事儿科学》《新生儿重症监护医学》。专业特长儿童肾脏病和感染性疾病的诊断和治疗。ORCID:0000-0002-3144-1437
基金资助:
NIE Xiaojing, CHEN Yi
Received:
2023-07-31
Online:
2023-12-15
Published:
2023-12-04
摘要:
IgA血管炎(IgA vasculitis,IgAV)是儿童时期最常见的全身性小血管炎,其累及肾脏时被称作IgAV肾炎(IgA vasculitis with nephritis,IgAVN),约20%IgAVN患者可发展为慢性肾脏病,其所致的儿童终末期肾病(ESRD)占ESRD病因构成的1%~2%。识别IgAVN预后的危险因素并及时给予有效干预,对改善患儿预后具有重要意义。本文就影响儿童IgAVN预后的危险因素进行阐述,以期为临床决策提供参考。
聂晓晶, 陈伊. 儿童IgA血管炎肾炎预后危险因素分析[J]. 临床儿科杂志, 2023, 41(12): 895-902.
NIE Xiaojing, CHEN Yi. Analysis of prognostic risk factors of IgA vasculitis with nephritis in children[J]. Journal of Clinical Pediatrics, 2023, 41(12): 895-902.
[1] |
Davin JC, Coppo R. Henoch-Schönlein purpura nephritis in children[J]. Nat Rev Nephrol, 2014, 10(10): 563-573.
doi: 10.1038/nrneph.2014.126 |
[2] |
Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised international Chapel Hill consensus conference nomen-clature of vasculitides[J]. Arthritis Rheum, 2013, 65(1): 1-11.
doi: 10.1002/art.v65.1 |
[3] |
Oni L, Sampath S. Childhood IgA vasculitis (Henoch Schönlein Purpura)-advances and knowledge gaps[J]. Front Pediatr, 2019, 7: 257.
doi: 10.3389/fped.2019.00257 |
[4] |
Calviño MC, Llorca J, García-Porrúa C, et al. Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study[J]. Medicine (Baltimore), 2001, 80(5): 279-290.
doi: 10.1097/00005792-200109000-00001 |
[5] |
Calvo-Río V, Loricera J, Mata C, et al. Henoch-Schönlein purpura in northern Spain: clinical spectrum of the disease in 417 patients from a single center[J]. Medicine (Baltimore), 2014, 93(2): 106-113.
doi: 10.1097/MD.0000000000000019 |
[6] |
Kang Y, Park JS, Ha YJ, et al. Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura[J]. J Korean Med Sci, 2014, 29(2): 198-203.
doi: 10.3346/jkms.2014.29.2.198 pmid: 24550645 |
[7] |
Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature[J]. Semin Arthritis Rheum, 2005, 35(3): 143-153.
doi: 10.1016/j.semarthrit.2005.08.007 |
[8] |
Soylemezoglu O, Ozkaya O, Ozen S, et al. Henoch-Schönlein nephritis: a nationwide study[J]. Nephron Clin Pract, 2009, 112(3): c199-c204.
doi: 10.1159/000218109 |
[9] | Nong BR, Huang YF, Chuang CM, et al. Fifteen-year experience of children with Henoch-Schönlein purpura in southern Taiwan, 1991-2005[J]. J Microbiol Immunol Infect, 2007, 40(4): 371-376. |
[10] |
Goldstein AR, White RH, Akuse R, et al. Long-term follow-up of childhood Henoch-Schönlein nephritis[J]. Lancet, 1992, 339(8788): 280-282.
doi: 10.1016/0140-6736(92)91341-5 pmid: 1346291 |
[11] |
Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study[J]. Lancet, 2002, 360(9334): 666-670.
doi: 10.1016/S0140-6736(02)09835-5 pmid: 12241872 |
[12] |
Gardner-Medwin JMM, Dolezalova P, Cummins C, et al. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins[J]. Lancet, 2002, 360(9341): 1197-1202.
doi: 10.1016/S0140-6736(02)11279-7 pmid: 12401245 |
[13] |
Kang Z, Xun M, Li Z, et al. Association of the clinicopathological characteristics and proteinuria remission of pediatric IgAV with nephrotic-range proteinuria: a retrospective cohort study[J]. Front Pediatr, 2022, 10: 959212.
doi: 10.3389/fped.2022.959212 |
[14] |
Kurt-Şükür ED, Sekar T, Tullus K. Biopsy-proven Henoch-Schönlein purpura nephritis: a single center experience[J]. Pediatr Nephrol, 2021, 36(5): 1207-1215.
doi: 10.1007/s00467-020-04809-8 pmid: 33089378 |
[15] |
李华荣, 陈朝英, 涂娟, 等. 儿童紫癜性肾炎预后不良相关因素分析[J]. 中华肾脏病杂志, 2020, 36(7): 535-542.
doi: 10.3760/cma.j.cn441217-20191125-00098 |
[16] |
Taal MW, Brenner BM. Renal risk scores: progress and prospects[J]. Kidney Int, 2008, 73(11): 1216-1219.
doi: 10.1038/ki.2008.36 pmid: 18322541 |
[17] | Verhave JC, Gansevoort RT, Hillege HL, et al. An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population[J]. Kidney Int Suppl, 2004, 66(92):S18-S21. |
[18] |
Iseki K, Ikemiya Y, Iseki C, et al. Proteinuria and the risk of developing end-stage renal disease[J]. Kidney Int, 2003, 63(4): 1468-1474.
doi: 10.1046/j.1523-1755.2003.00868.x pmid: 12631363 |
[19] |
Piram M, Maldini C, Biscardi S, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study[J]. Rheumatology (Oxford), 2017, 56(8): 1358-1366.
doi: 10.1093/rheumatology/kex158 pmid: 28444335 |
[20] |
Shi M, Yu S, Ouyang Y, et al. Increased lifetime risk of ESRD in familial IgA nephropathy[J]. Kidney Int Rep, 2021, 6(1) : 91-100.
doi: 10.1016/j.ekir.2020.10.015 pmid: 33426388 |
[21] |
Kiryluk K, Moldoveanu Z, Sanders J T, et al. Aberrant glycosylation of IgA1 is inherited in both pediatric IgA nephropathy and Henoch-Schönlein purpura nephritis[J]. Kidney Int, 2011, 80(1): 79-87.
doi: 10.1038/ki.2011.16 pmid: 21326171 |
[22] |
Mir S, Yavascan O, Mutlubas F, et al. Clinical outcome in children with Henoch-Schönlein nephritis[J]. Pediatr Nephrol, 2007, 22(1): 64-70.
doi: 10.1007/s00467-006-0278-0 pmid: 17024391 |
[23] | 冯丹, 郝胜, 钮小玲, 等. 儿童紫癜性肾炎预后的相关因素分析[J]. 中华实用儿科临床杂志, 2016, (9): 679-682. |
[24] | Counahan R, Winterborn MH, White RH, et al. Prognosis of Henoch-Schönlein nephritis in children[J]. Br Med J, 1977, 2(6078): 11-14. |
[25] |
Algoet C, Proesmans W. Renal biopsy 2-9 years after Henoch Schönlein purpura[J]. Pediatr Nephrol, 2003, 18(5): 471-473.
doi: 10.1007/s00467-003-1132-2 pmid: 12736812 |
[26] |
Wakaki H, Ishikura K, Hataya H, et al. Henoch-Schönlein purpura nephritis with nephrotic state in children: predictors of poor outcomes[J]. Pediatr Nephrol, 2011, 26(6): 921-925.
doi: 10.1007/s00467-011-1827-8 pmid: 21373776 |
[27] | 刘钧菲, 王华. 过敏性紫癜患儿抗凝纤溶系统标志物的动态变化[J]. 临床儿科杂志, 2012, 30(6): 547-551. |
[28] |
李雪倩, 刘小荣, 姚兴凤, 等. 牛津分类与国际小儿肾脏病研究组分级在评价儿童紫癜性肾炎预后中的应用[J]. 中华肾脏病杂志, 2020, 36(1): 26-33.
doi: 10.3760/cma.j.issn.1001-7097.2020.01.005 |
[29] | 中华医学会儿科学分会肾脏学组. 紫癜性肾炎诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55 (9): 647-651. |
[30] |
Davin JC. Henoch-Schönlein purpura nephritis: pathophysiology, treatment, and future strategy[J]. Clin J Am Soc Nephrol, 2011, 6(3): 679-689.
doi: 10.2215/CJN.06710810 |
[31] |
Jelusic M, Sestan M, Cimaz R, et al. Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used?[J]. Pediatr Rheumatol Online J, 2019, 17(1): 10.
doi: 10.1186/s12969-019-0311-z pmid: 30819179 |
[32] |
Edström Halling S, Söderberg MP, Berg UB. Predictors of outcome in Henoch-Schönlein nephritis[J]. Pediatr Nephrol, 2010, 25(6): 1101-1108.
doi: 10.1007/s00467-010-1444-y pmid: 20174831 |
[33] |
Coppo R, Andrulli S, Amore A, et al. Predictors of outcome in Henoch-Schönlein nephritis in children and adults[J]. Am J Kidney Dis, 2006, 47(6) : 993-1003.
doi: 10.1053/j.ajkd.2006.02.178 pmid: 16731294 |
[34] |
Roberts ISD, Cook HT, Troyanov S, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility[J]. Kidney Int, 2009, 76(5): 546-556.
doi: 10.1038/ki.2009.168 pmid: 19571790 |
[35] |
Trimarchi H, Barratt J, Cattran DC, et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group[J]. Kidney Int, 2017, 91(5): 1014-1021.
doi: S0085-2538(17)30101-1 pmid: 28341274 |
[36] |
Yun D, Kim DK, Oh KH, et al. MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis[J]. BMC Nephrol, 2020, 21(1): 33.
doi: 10.1186/s12882-020-1691-5 pmid: 32000703 |
[37] |
Wang M, Wang R, He X, et al. Using MEST-C scores and the international study of kidney disease in children classification to predict outcomes of Henoch-Schönlein purpura nephritis in children[J]. Front Pediatr, 2021, 9: 658845.
doi: 10.3389/fped.2021.658845 |
[38] |
Delbet JD, Geslain G, Auger M, et al. Histological prognostic factors in children with Henoch-Schönlein purpura nephritis[J]. Pediatr Nephrol, 2020, 35(2): 313-320.
doi: 10.1007/s00467-019-04363-y |
[39] |
Koskela M, Ylinen E, Ukonmaanaho EM, et al. The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch-Schönlein purpura nephritis[J]. Pediatr Nephrol, 2017, 32(7): 1201-1209.
doi: 10.1007/s00467-017-3608-5 pmid: 28197887 |
[40] |
Zhong X, Ding J. Diagnosis and treatment of IgA nephropathy and IgA vasculitis nephritis in Chinese children[J]. Pediatr Nephrol, 2023, 38(6): 1707-1715.
doi: 10.1007/s00467-022-05798-6 |
[41] |
Delbet JD, Parmentier C, Herbez Rea C, et al. Management of IgA vasculitis with nephritis[J]. Paediatr Drugs, 2021, 23(5): 425-435.
doi: 10.1007/s40272-021-00464-0 |
[42] |
Deki S, Hamada R, Mikami N, et al. Half of children with IgA vasculitis-associated nephritis with nephrotic state spontaneously recover[J]. Nephrology (Carlton), 2022, 27(8): 681-689.
doi: 10.1111/nep.v27.8 |
[43] |
Davin JC, Coppo R. Pitfalls in recommending evidence-based guidelines for a protean disease like Henoch-Schönlein purpura nephritis[J]. Pediatr Nephrol, 2013, 28(10): 1897-1903.
doi: 10.1007/s00467-013-2550-4 |
[44] |
Ozen S, Marks SD, Brogan P, et al. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative[J]. Rheumatology (Oxford), 2019, 58(9): 1607-1616.
doi: 10.1093/rheumatology/kez041 pmid: 30879080 |
[45] |
Kawasaki Y, Suzuki J, Nozawa R, et al. Efficacy of methylprednisolone and urokinase pulse therapy for severe Henoch-Schönlein nephritis[J]. Pediatrics, 2003, 111(<W>4 Pt 1):785-789.
doi: 10.1542/peds.111.4.785 pmid: 12671112 |
[46] |
Song Y, Huang X, Yu G, et al. Pathogenesis of IgA vasculitis: an up-to-date review[J]. Front Immunol, 2021, 12: 771619.
doi: 10.3389/fimmu.2021.771619 |
[47] | Novak J, Rizk D, Takahashi K, et al. New insights into the pathogenesis of IgA nephropathy[J]. Kidney Dis (Basel), 2015, 1(1): 8-18. |
[48] |
Zhao N, Hou P, Lv J, et al. The level of galactose-deficient IgA1 in the sera of patients with IgA nephropathy is associated with disease progression[J]. Kidney Int, 2012, 82(7): 790-796.
doi: 10.1038/ki.2012.197 pmid: 22673888 |
[49] |
Heineke MH, Ballering AV, Jamin A, et al. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schönlein purpura)[J]. Autoimmun Rev, 2017, 16(12): 1246-1253.
doi: S1568-9972(17)30259-8 pmid: 29037908 |
[50] |
Launay P, Grossetête B, Arcos-Fajardo M, et al. Fcalpha receptor (CD89) mediates the development of immunoglobulin A (IgA) nephropathy (Berger's disease). Evidence for pathogenic soluble receptor-Iga complexes in patients and CD89 transgenic mice[J]. J Exp Med, 2000, 191(11): 1999-2009.
doi: 10.1084/jem.191.11.1999 pmid: 10839814 |
[51] |
Vuong MT, Hahn-Zoric M, Lundberg S, et al. Association of soluble CD89 levels with disease progression but not susceptibility in IgA nephropathy[J]. Kidney Int, 2010, 78(12): 1281-1287.
doi: 10.1038/ki.2010.314 pmid: 20811333 |
[52] |
Davin JC, Ten Berge IJ, Weening JJ. What is the difference between IgA nephropathy and Henoch-Schönlein purpura nephritis?[J]. Kidney Int, 2001, 59(3): 823-834.
doi: 10.1046/j.1523-1755.2001.059003823.x pmid: 11231337 |
[53] |
Yang YH, Tsai IJ, Chang CJ, et al. The interaction between circulating complement proteins and cutaneous microvascular endothelial cells in the development of childhood Henoch-Schönlein Purpura[J]. PLoS One, 2015, 10(3): e0120411.
doi: 10.1371/journal.pone.0120411 |
[54] |
Dumont C, Mérouani A, Ducruet T, et al. Clinical relevance of membrane attack complex deposition in children with IgA nephropathy and Henoch-Schönlein purpura[J]. Pediatr Nephrol, 2020, 35(5): 843-850.
doi: 10.1007/s00467-019-04445-x pmid: 31932958 |
[55] |
Takemura T, Yoshioka K, Murakami K, et al. Cellular localization of inflammatory cytokines in human glomerulonephritis[J]. Virchows Arch, 1994, 424(5): 459-464.
pmid: 8032526 |
[56] |
Del Vecchio GC, Penza R, Altomare M, et al. Cytokine pattern and endothelium damage markers in Henoch-Schönlein purpura[J]. Immunopharmacol Immunotoxicol, 2008, 30(3): 623-629.
doi: 10.1080/08923970801973646 |
[57] | Wu H, Wen Y, Yue C, et al. Serum TNF-α level is associated with disease severity in adult patients with immunoglobulin A vasculitis nephritis[J]. Dis Markers, 2020: 1-7. |
[58] |
Wang K, Sun X, Jing S, et al. Development and validation of nomogram prediction model for severe kidney disease in children with Henoch-Schönlein purpura: A prospective analysis of two independent cohorts-forecast severe kidney disease outcome in 2,480 hospitalized Henoch-Schönlein purpura children[J]. Front Immunol, 2022, 13: 999491.
doi: 10.3389/fimmu.2022.999491 |
[59] | He M, Li C, Kang Y, et al. Clinical predictive model for the 1-year remission probability of IgA vasculitis nephritis[J]. Int Immunopharmacol, 2021, 101(Pt B): 108341. |
[60] |
Song Z, Nie Y, Yang L, et al. Predicting severe renal and gastrointestinal involvement in childhood immunoglobulin A vasculitis with routine laboratory parameters[J]. Dermatology, 2022, 238(4): 745-752.
doi: 10.1159/000519665 |
[61] |
Wang J, Chu H, Pan Y. Prediction of renal damage in children with IgA vasculitis based on machine learning[J]. Medicine (Baltimore), 2022, 101(42): e31135.
doi: 10.1097/MD.0000000000031135 |
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