本文選題：兒童 + IgA腎病�。� 參考：《山東大學》2014年碩士論文

【摘要】：研究背景：IgA腎病是兒童時期常見的腎小球疾病,腎活檢免疫病理檢查可見腎小球系膜區(qū)有以IgA為主的顆粒樣沉積。以反復(fù)發(fā)作肉眼血尿或鏡下血尿為主要臨床表現(xiàn),可伴有不同程度的蛋白尿。臨床表現(xiàn)差異大,輕者僅表現(xiàn)鏡下血尿,嚴重者呈急進性腎炎。其臨床呈慢性進展過程,IgA腎病已成為導(dǎo)致終末期腎病的主要原因之一。雖然經(jīng)過40多年長期的臨床觀察和病理研究,但由于IgA腎病的發(fā)病機制復(fù)雜,目前仍未完全清楚,其臨床表現(xiàn)和病理的多樣性和不平行性,目前尚無統(tǒng)一的臨床分型和病理分類方法,更無統(tǒng)一和特效的治療方案。積極應(yīng)對IgA腎病已經(jīng)成為兒科腎臟病醫(yī)師的共識,及早診斷,根據(jù)不同臨床表現(xiàn)和病理改變進行治療,以改善患兒預(yù)后。 目的：本研究旨在分析兒童原發(fā)性IgA腎病的臨床表現(xiàn)與病理特點,了解其臨床表現(xiàn)與病理改變的關(guān)系,以指導(dǎo)臨床治療。 研究方法：對2006-2013年山東省立醫(yī)院收治并經(jīng)腎穿刺活檢確診的110例原發(fā)性IgA腎病患兒的臨床資料進行回顧性分析,觀察不同臨床表現(xiàn)及病理類型的特點,了解其臨床表現(xiàn)與病理分級的關(guān)系。 結(jié)果：(1)2006年1月至2013年12月,山東省立醫(yī)院≤14歲經(jīng)腎活檢確診的IgAN患兒共110例,資料完整者110例,男性多見,男：女為1.68：1,確診年齡為8.64±2.29歲。(2)50%患兒起病有誘因,其中大多為上呼吸道感染,其次為胃腸道感染。(3)臨床表現(xiàn)以肉眼血尿(伴或不伴蛋白尿)為主訴者最常見(65例,59.1%)。臨床分型中以血尿蛋白尿型最常見54例(49.1%),其次為腎病綜合征型40例(36.4%)。(4)病理分級以ⅠⅡ級(59例,53.6%)多見；免疫熒光檢查以IgA類型的最多,有46例(41.8%)；(5)臨床表現(xiàn)與病理分級之間存在顯著相關(guān)性；免疫復(fù)合物沉積與WHO病理分型之間存在相關(guān)性；免疫復(fù)合物中IgA與C3沉積之間存在相關(guān)性,二者之間存在正相關(guān)；(6)IgA腎病預(yù)后的危險因素的logistic回歸分析,尿蛋白為病理損害程度的獨立危險因素。 結(jié)論：(1)兒童原發(fā)性IgAN男性多見。(2)臨床表現(xiàn)以血尿蛋白尿型為多見。(3)病理表現(xiàn)以Ⅱ級和Ⅲ級為主。免疫熒光以IgA類型的多見,免疫復(fù)合物IgA與C3沉積存在正相關(guān),臨床表現(xiàn)較重者病理損害越重,單純IgA沉積者病理損害較輕。(4)尿蛋白為病理損害程度的獨立危險因素。
[Abstract]:Background: IgA nephropathy is a common glomerular disease in childhood. The glomerular Mesangial area has granular deposition mainly in glomerular Mesangial area by renal biopsy immunopathology. Repeated episodes of hematuria or hematuria under microscope are the main clinical manifestations, and may be accompanied by varying degrees of proteinuria. The clinical manifestation is big, the light person only presents the microscopic hematuria, the severe person presents the rapid progress nephritis. The chronic progression of IgA nephropathy has become one of the main causes of end-stage nephropathy. Although after more than 40 years of clinical observation and pathological study, the pathogenesis of IgA nephropathy is complex, and its clinical manifestations and pathology are diverse and non-parallel. At present, there is no uniform clinical classification and pathological classification, let alone a unified and effective treatment. It has become a common understanding among pediatric nephrologists to actively deal with IgA nephropathy, to diagnose early and treat according to different clinical manifestations and pathological changes in order to improve the prognosis of children. Objective: to analyze the clinical and pathological features of primary IgA nephropathy in children and to understand the relationship between its clinical manifestations and pathological changes in order to guide the clinical treatment. Methods: the clinical data of 110 children with primary IgA nephropathy admitted to Shandong Provincial Hospital from 2006 to 2013 and confirmed by renal biopsy were retrospectively analyzed, and the characteristics of different clinical manifestations and pathological types were observed. To understand the relationship between clinical manifestation and pathological grade. Results from January 2006 to December 2013, 110 cases of IgAN were diagnosed by renal biopsy in Shandong Provincial Hospital. The data were complete in 110 cases. Male: female was 1.68: 1. The diagnosis age was 8.64 鹵2.29 years old. Most of them were upper respiratory tract infection, followed by gastrointestinal tract infection. The most common clinical manifestation was naked hematuria (with or without proteinuria) in 65 cases. In the clinical classification, the most common type of hematuria and proteinuria was 49.1%, followed by 40 cases of nephrotic syndrome with 36.4%, 59 cases with grade 鈪，

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