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目的探讨儿童原发性IgA肾病(IgAN)的免疫、病理特点及其预后影响因素。方法选择1999年8月-2010年8月本院确诊的48例IgAN儿童,分析其临床资料并进行长期随访,根据随访终点时的临床表现分为A、B、C、D 4种结局作为预后评估指标。采用多因素分析评估影响预后的危险因素。结果 1.体液免疫:29.3%患儿血IgA升高,39.0%血IgG降低;细胞免疫:近50%的患儿细胞免疫指标不正常。2.病理结果:采用Lee氏分级,Ⅱ级25例,Ⅲ级18例,Ⅳ级5例,未发现Ⅰ和Ⅴ级。70.8%伴肾间质受损。免疫荧光以IgA+IgG+IgM沉积者占58.3%,单独IgA沉积者仅占6.3%。3.预后:A级29例(60.4%);B级15例(31.3%);C级4例(8.3%);未发现D级。4.影响预后因素:经Logistic回归分析,病理Ⅳ级与预后有关(P<0.05);高血压、大量蛋白尿和肾衰竭对预后影响无统计学意义。结论儿童IgAN存在免疫紊乱,但预后较好;肾脏病理分级是影响儿童IgAN预后的重要因素。
Objective To investigate the immune, pathological features and prognostic factors of children with primary IgA nephropathy (IgAN). Methods 48 cases of IgAN children diagnosed in our hospital from August 1999 to August 2010 were selected and analyzed. The clinical data were analyzed and followed up for a long term. According to the clinical manifestations at the end of follow-up, the patients were divided into 4 groups: A, B, C and D, Evaluation indicators. Multivariate analysis was used to assess the risk factors affecting prognosis. Humoral immunity: 29.3% of children with elevated serum IgA, 39.0% decreased serum IgG; cellular immunity: nearly 50% of children with abnormal cellular immune indicators. Pathological results: Lee’s classification, Ⅱ grade 25 cases, Ⅲ grade 18 cases, Ⅳ grade 5 cases, no grade Ⅰ and Ⅴ were found. 70.8% with renal interstitial damage. Immunofluorescence accounted for 58.3% IgA + IgG + IgM deposition, IgA deposition alone accounted for only 6.3%. Prognosis: Grade A was 29 (60.4%); Grade B was 15 (31.3%); Grade C was 4 (8.3%); grade D was not found. 4. Influencing prognostic factors: Logistic regression analysis showed that pathological grade Ⅳ was associated with prognosis (P <0.05); hypertension, massive proteinuria and renal failure had no significant effect on prognosis. Conclusion There is immune disorder in children with IgAN, but the prognosis is good. Renal pathological grade is an important factor affecting the prognosis of children with IgAN.