儿童狼疮性肾炎45例临床、病理及免疫学分析

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (3): 246-249.

儿童狼疮性肾炎45例临床、病理及免疫学分析

成学琴，鲍华英，张爱华，丁桂霞，赵非

南京医科大学附属南京儿童医院肾脏科（江苏南京　210008）

收稿日期:2013-09-08 出版日期:2014-03-15 发布日期:2014-03-15

Clinical and immunological features of 45 children with lupus nephritis

CHENG Xueqin, BAO Huaying, ZHANG Aihua, DING Guixia, ZHAO Fei

(Department of Nephrology, Nanjing Medical University, Nanjing 210008, Jiangsu, China)

Received:2013-09-08 Published:2014-03-15 Online:2014-03-15

摘要/Abstract

摘要：

　目的　探讨儿童狼疮性肾炎（LN）的临床、病理及免疫学特点。方法　回顾性分析住院治疗的45例LN患儿的临床和病理资料及免疫学指标。结果　45例LN患儿中男6例、女39例，平均发病年龄（10.9±2.8）岁。临床表现为急性肾炎综合征型最常见，占42.2%，肾病综合征占31.1 %。42例进行病理分型，其中Ⅱ型8例（17.8%），Ⅲ 型2例（4.4%），Ⅳ 型22例（48.9%），Ⅴ型1例（2.2%），Ⅴ＋Ⅲ型3例（6.7%），Ⅴ＋Ⅳ型6例（13.3%）。在治疗初期临床缓解率达91.1%，随访24个月15.0%复发。结论　LN患儿的临床表现具有多样性，肾脏病理复杂多变，部分患儿临床表现与肾脏病理表现不一致。

Abstract: 　Objective　To analyze the clinical and immunological features of 45 pediatric patients with lupus nephritis (LN). Methods Forty-five LN patients were included in this study. Clinical, pathological data and immunological parameters were retrospectively analyzed. Results Forty-five LN patients had 6 males and 39 females, with the mean onset age of (10.9 ± 2.8) years. Acute nephritis was the most common type, accounting for 42.2%. Nephrotic syndrome accounted for 31.1%. Renal biopsy showed class II (17.8%), III (4.4%), IV (48.9%), V (2.2％), V＋III (6.7%） and V＋IV (13.3%） in 42 cases. The remission rate reached 91.1% in the early therapeutic stage, and 15.0% patients recurred after 24-month follow-up. Conclusions The clinical manifestations of LN children are diverse. The renal pathology is complex. The clinical manifestations in part of the children are not consistent with renal pathology.

成学琴，鲍华英，张爱华，丁桂霞，赵非. 儿童狼疮性肾炎45例临床、病理及免疫学分析[J]. 临床儿科杂志, 2014, 32(3): 246-249.

CHENG Xueqin,BAO Huaying,ZHANG Aihua,DING Guixia,ZHAO Fei. Clinical and immunological features of 45 children with lupus nephritis[J]. , 2014, 32(3): 246-249.

参考文献

[1] Lau KK, Jones DP, Ault BH. Prognosis of lupus membranous nephritis in children [J]. Lupus, 2007, 16 (1) : 70.
[2] Ding L，Zhao M，Zou W，et al. Mycophenolate mofetil combined with prednisone for diffuse proliferative lupus nephritis：a histopathological study [J]. Lupus, 2004，13（2）：113 - 118.
[3] 易著文. 儿童常见肾脏疾病诊治循证指南（试行）解读（六）：狼疮性肾炎诊断治疗 [J]. 中华儿科杂志，2010,48（9）:695-697.
[4] Bertsias GK, Tektonidou M, Amoura Z，et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult andpaediatric lupus nephritis [J]. Ann Rheum Dis, 2012,71(11):1771-1782.
[5] 王海燕. 肾脏病学 [M]. 北京: 人民卫生出版社, 1996: 861- 891.
[6] 邹万忠, 王海燕. 狼疮肾炎病理学分类的演变和现状 [J]. 中华肾脏病杂志, 2004, 20 (5) : 377 - 379.
[7] Agarwal I, Kumar TS, Ranjini K，et al. Clinical features and outcome of systemic lupus erythematosus [J]. Indian Pediatr, 2009, 46(8):711-715.
[8] 张巧玲, 蒋小云, 莫樱, 等. 儿童狼疮性肾炎临床与病理特点及相关性分析 [ J]. 临床儿科杂志, 2009, 27(4): 317-320.
[9] 张力, 姚勇, 黄建萍, 等. 狼疮性肾炎男性患儿24 例临床分析 [J]. 中国实用儿科杂志, 2009, 24(8) : 627-630.
[10] Atta AM, Pereira MM, Santiago M, et al. Anti-ds DNA antibodies in Brazilian patients of mainly African descent with systemic lupus erythematosus: lack of association with lupus nephritis [J]. Clin Rheumatol, 2009, 28(6): 693-697.
[11] 何威逊, 朱光华, 方明俊, 等. 狼疮性肾炎35例的临床、病理与治疗 [J]. 实用儿科临床杂志, 2005, 20(9): 895-897.
[12] Ho A, Barr SG, Magder LS, et al. A decrease in complement is associated with increased renal and hematologic activity in patients with systemic lupus erythematosus [J]. Arthritis Rheum, 2001, 44(10): 2350-2357.