本文選題：無癥狀血尿　切入點：腎活檢　出處：《臨床兒科雜志》2017年07期

【摘要】：目的探討無癥狀血尿兒童的腎穿刺指征。方法回顧分析485例無癥狀血尿兒童的腎臟病理類型。根據血尿程度及有無合并蛋白尿將入組患兒分為,鏡下血尿組、肉眼血尿組和血尿合并蛋白尿組;其中鏡下血尿組再根據血尿程度分為尿紅細胞15/HPF組,15~30/HPF組和30/HPF組。結果 485例患兒中,男227例、女258例,平均(7.23±2.93)歲;鏡下血尿組318例,最常見病理類型為輕微病變(64.8%),其次為局灶性腎小球病變(16.7%)和局灶節(jié)段性腎小球硬化(8.2%);肉眼血尿組119例,最常見病理類型也是輕微病變(26.1%),其次為Ig A腎病(24.4%)和系膜增生性腎小球疾病(20.2%);血尿合并蛋白尿組48例,最常見病理類型為Ig A腎病(29.2%)和輕微病變(29.2%)。鏡下血尿組、肉眼血尿組和血尿合并蛋白尿組的病理類型分布差異有統(tǒng)計學意義(χ~2=152.03,P0.001);其中鏡下血尿組的輕微病變比例最高;IgA腎病和系膜增生性腎小球腎炎比例在在肉眼血尿和血尿合并蛋白尿組中比例較高。鏡下血尿組中,尿紅細胞15/HPF組149例,(15~30)/HPF組96例,30/HPF組73例,三組間病理類型構成差異無統(tǒng)計學意義(χ~2=15.18,P=0.512);最常見病理類型均為輕微病變。結論無癥狀血尿者中,為肉眼血尿或者血尿合并蛋白尿者應盡早行腎穿刺明確病理診斷。
[Abstract]:Objective to study the renal puncture indications in children with asymptomatic hematuria. Methods the renal pathological types of 485 children with asymptomatic hematuria were retrospectively analyzed. The children were divided into two groups according to the degree of hematuria and the presence or absence of proteinuria. According to the degree of hematuria, the hematuria group was divided into 1530% HPF group and 30/HPF group according to the degree of hematuria. Results there were 227 males and 258 females with an average age of 7.23 鹵2.93 years, 318 cases in the hematuria group. The most common pathological types were slight pathological changes (64.8%), focal glomerular lesions (16.7%) and focal segmental glomerulosclerosis (8.2%). The most common pathological types were mild pathological changes (26.1cm), IgA nephropathy (24.4kb) and Mesangial proliferative glomerular diseases (20.2g); hematuria with proteinuria group (48 cases), the most common pathological types were IgA nephropathy (29.2g) and mild pathological changes (29.2g). There was significant difference in the distribution of pathological types between hematuria group and hematuria combined with proteinuria group (蠂 ~ 2 / 2 152.03 / P 0.001), in which IgA nephropathy and Mesangial proliferative glomerulonephritis were the highest in microscopic hematuria group (P < 0.05), and the ratio of microscopic hematuria group and Mesangial proliferative glomerulonephritis group was higher than that in naked eye hematuria and blood group (P < 0.05). The proportion of urine combined with proteinuria was higher. There was no significant difference in pathological types among the three groups (蠂 ~ (2 / 2) 15.18) P ~ (0.512), and the most common pathological types were mild lesions. Conclusion in asymptomatic hematuria, there is no significant difference between the three groups. Renal puncture should be performed as early as possible for the diagnosis of gross hematuria or hematuria with proteinuria.
【作者單位】： 上海交通大學醫(yī)學院附屬新華醫(yī)院小兒腎臟內科;
【基金】：新華醫(yī)院臨床課題基金(No.15LC02)
【分類號】：R726.9

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