目的 研究原发性IgA肾病患儿不同程度蛋白尿与肾脏病理改变的相关性,为临床诊疗及病情评估提供线索.方法 选取2005年8月至2015年7月在中国医科大学附属第一医院儿科行肾活检病理检查诊断为IgA肾病(IgAN)的患儿32例,按照24 h尿蛋白(UP)水平分为3组:轻度组(UP＜ 0.5 g)17例,中度组(0.5 g≤UP≤2.0 9)9例,重度组(UP＞ 2.0 g)6例.回顾性分析患儿的临床及肾脏病理材料.结果 轻度、中度、重度蛋白尿患儿分别占53.1％、28.1％和18.8％;蛋白尿与肾小球积分、肾小管间质积分正相关(r=0.399,0.469,P＜0.05);肾脏病理分级以Ⅱ、Ⅲ级多见,各14例(43.8％),随着蛋白尿程度增加,病理损伤程度有加重趋势(P＜ 0.05);13例(40.6％)患儿出现新月体病变,随着蛋白尿程度增加,新月体病变发生率增加(P＜0.05).结论 IgA肾病患儿的蛋白尿程度与其肾脏病理损伤程度存在相关性,蛋白尿水平在一定程度上可反映肾小球和肾小管间质的病理损伤程度;轻度蛋白尿的IgA肾病患儿也有进展为终末期肾病的可能,需给予积极降尿蛋白治疗,延缓疾病进展.%Objective To investigate the correlation between different levels of proteinuria and renal pathological lesion in children with primary IgA nephropathy,in order to provide references for the treatment and condition assessment.Methods A total of 32 IgAN patients with a renal biopsy from the Pediatric Department of the First Affiliated Hospital of China Medical University from August 2005 to July 2015 were chosen.According to the level of 24 h urinary protein (UP),the 32 cases were separated into 3 groups:mild group(UP ＜ 0.5 g,n =17),moderate group(0.5-2.0 g,n =9) and severe group(UP ＞ 2 g,n =6).Their clinical and pathological data were studied retrospectively.Results The proportion of patients with mild,moderate and severe proteinuria were 53.1％,28.1％ and 18.8％ respectively.Proteinuria was positively correlated with glomerular integral and tubular interstitial integral(P ＜ 0.05).The majority of pathological changes of IgAN were grade Ⅱ and grade Ⅲ,each with 14 cases (43.8％).With the increasing level of albuminuria,the degree of pathological damage increased (P ＜ 0.05).Crescentic lesions were found in 13 cases (40.6％),and with the increasing degree of the proteinuria,the incidence of crescent lesions had an increasing tendency (P ＜ 0.05).Conclusion There is correlation between proteinuria and renal pathological changes in children with IgA nephropathy.The level of proteinuria can reflect the pathological damage of glomerular and renal tubule to a certain extent.Children with mild proteinuria,who have IgA nephropathy,also have the potential to progress to ESRD.They need to be treated actively to reduce urinary protein and delay the progression of the disease.
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