[伴有不同比例新月体形成的免疫球蛋白A血管炎伴肾炎患儿的临床及病理特征]

[Clinical and pathological features of children with immunoglobulin A vasculitis with nephritis accompanied by different proportions of crescent formation].

作者信息

Bai Meng-Ke, Wang Long, Li Hang, Su Hang, Yang Yue-Li, Yang Xiao-Qing

机构信息

Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2024 Dec 15;26(12):1329-1334. doi: 10.7499/j.issn.1008-8830.2407060.

DOI:10.7499/j.issn.1008-8830.2407060

PMID:39725397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11684822/

Abstract

OBJECTIVES

To investigate the impact of the different proportions of crescent formation on clinical manifestations and pathological features in children with immunoglobulin A vasculitis with nephritis (IgAVN).

METHODS

The children with IgAVN were divided into no-crescent group (75 children), ≤25% crescent group (156 children), and >25% crescent group (33 children).

RESULTS

Compared with the no-crescent group, the other two groups had significant increases in 24-hour urinary protein, urinary immunoglobulin G (IgG)/creatinine ratio, urine red blood cell count, fibrinogen, and neutrophil-lymphocyte ratio, a significant reduction in serum IgG, and a significantly higher proportion of children with low albumin and hypercoagulability, pathological grade III+IV or diffuse mesangial proliferation (<0.05). Compared with the ≤25% crescent group, the >25% crescent group had significant increases in 24-hour urinary protein, urine red blood cell count, and fibrinogen, significant reductions in serum IgG and glomerular filtration rate, and a significantly higher proportion of children with diffuse mesangial proliferation, tubular atrophy or interstitial fibrosis (<0.05). Compared with the no-crescent group, the >25% crescent group had significantly higher levels of total cholesterol, triglycerides, urea nitrogen, and serum creatinine (<0.05). A reduction in serum IgG, hypercoagulability, an increase in 24-hour urinary protein, diffuse mesangial proliferation, and chronic tubulointerstitial lesions were influencing factors for the increase in the proportion of crescent formation (<0.05).

CONCLUSIONS

For children with IgAVN, the higher proportion of crescent formation is associated with greater abnormalities in laboratory markers and more severe chronic tubulointerstitial lesions, and thus a detailed analysis of the proportion of crescent formation can better guide clinical treatment.

摘要

目的

探讨新月体形成的不同比例对儿童免疫球蛋白A血管炎伴肾炎（IgAVN）临床表现及病理特征的影响。

方法

将IgAVN患儿分为无新月体组（75例患儿）、新月体≤25%组（156例患儿）和新月体>25%组（33例患儿）。

结果

与无新月体组相比，其他两组24小时尿蛋白、尿免疫球蛋白G（IgG）/肌酐比值、尿红细胞计数、纤维蛋白原及中性粒细胞-淋巴细胞比值显著升高，血清IgG显著降低，低白蛋白及高凝状态患儿比例显著更高，病理分级为III+IV级或弥漫性系膜增生的比例更高（<0.05）。与新月体≤25%组相比，新月体>25%组24小时尿蛋白、尿红细胞计数及纤维蛋白原显著升高，血清IgG及肾小球滤过率显著降低，弥漫性系膜增生、肾小管萎缩或间质纤维化患儿比例显著更高（<0.05）。与无新月体组相比，新月体>25%组总胆固醇、甘油三酯、尿素氮及血清肌酐水平显著更高（<0.05）。血清IgG降低、高凝状态、24小时尿蛋白增加、弥漫性系膜增生及慢性肾小管间质病变是新月体形成比例增加的影响因素（<0.05）。