天津医药

天津医药 ›› 2026, Vol. 54 ›› Issue (7): 727-731.doi: 10.11958/20253189

• 临床研究 • 上一篇    下一篇

肾病综合征型儿童IgA血管炎肾炎的肾脏病理特征分析

苏杭1,2(), 花蕾2, 白梦刻1,2, 任献青1,2,△()   

  1. 1 河南中医药大学第一附属医院儿科医院 （邮编450046）
    2 河南中医药大学儿科医学院
  • 收稿日期:2025-10-20 修回日期:2026-02-03 出版日期:2026-07-15 发布日期:2026-07-13
  • 通讯作者: △E-mail：Renxq723@163.com
  • 作者简介:苏杭（1988），男，副主任医师，主要从事中医药防治小儿肾病及风湿免疫性疾病方面研究。E-mail：362504467@qq.com
  • 基金资助:
    河南省中医学“双一流”创建科学研究专项(HSRP-DFCTCM-2023-3-02)

Analysis of renal pathological characteristics of IgA vasculitis nephritis with nephrotic syndrome in children

SU Hang1,2(), HUA Lei2, BAI Mengke1,2, REN Xianqing1,2,△()   

  1. 1 Department of Pediatrics, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China
    2 College of Pediatrics, Henan University of Chinese Medicine
  • Received:2025-10-20 Revised:2026-02-03 Published:2026-07-15 Online:2026-07-13
  • Contact: △E-mail：Renxq723@163.com

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摘要：

目的 探讨肾病综合征（NS）型和非NS型的儿童IgA血管炎肾炎（IgAVN）的肾脏病理特征差异。方法 回顾性分析349例肾病水平蛋白尿的IgAVN患儿肾脏病理资料，根据是否合并NS分为NS组（56例）和非NS组（293例），比较2组的临床特征和病理类型差异。结果 349例IgAVN患儿整体以国际儿童肾脏病研究协作组（ISKDC） Ⅲ级以上病变为主（78.2%，273/349）；免疫荧光以IgA型沉积为主（74.8%，261/349），41.0%（143/349）的患儿伴C3沉积。24 h尿蛋白定量与病理分级、系膜增生程度、新月体比例呈正相关（均P<0.05）。与非NS组相比，NS组出现肉眼血尿、病理分级Ⅱb和Ⅳ级比例显著升高，重度系膜增生、新月体比例（≥25%）及肾小管间质损伤比例亦明显升高（均P<0.05）。结论 NS型IgAVN在新月体形成、重度系膜增生以及肾小管间质损伤方面更严重。

关键词: 血管炎, 肾炎, 免疫球蛋白A, 肾病综合征, 病理特点

Abstract:

Objective To investigate the differences in renal pathological features between nephrotic syndrome (NS) type and non-NS type in children with IgA vasculitis nephritis (IgAVN). Methods The renal pathological data of 349 children with IgAVN presenting with nephrotic-range proteinuria were retrospectively analyzed. According to the presence or absence of NS, patients were divided into the NS group (n=56) and the non-NS group (n=293). The clinical characteristics and pathological types were compared between the two groups. Results Among the 349 children with IgAVN, the majority showed ISKDC grade Ⅲ or higher lesions (78.2%, 273/349). Immunofluorescence was dominated by IgA deposition (74.8%, 261/349), and 41.0% (143/349) of the patients had concomitant C3 deposition. The 24-hour urinary protein quantification was positively correlated with pathological grading, mesangial proliferation degree and crescent proportion (all P<0.05). Compared with the non-NS group, the NS group had significantly higher proportions of gross hematuria, ISKDC gradeⅡb and Ⅳ lesions, severe mesangial proliferation, crescent proportion (≥25%) and tubulointerstitial injury (all P<0.05). Conclusion NS-type IgAVN is more severe in terms of crescent formation, severe mesangial proliferation and renal tubulointerstitial injury.

Key words: vasculitis, nephritis, immunoglobulin A, nephrotic syndrome, pathological characteristics

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