摘要
目的探讨儿童不典型急性链球菌感染后肾小球肾炎(APSGN)的临床特点。方法选择2015年10月至2019年6月,于广州市妇女儿童医疗中心诊治的12例不典型APSGN患儿为研究对象。回顾性分析其临床病例资料,包括临床表现、实验室检查及肾活检组织病理学检查结果、治疗和随访结果等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果12例不典型APSGN患儿均急性起病,9例为肉眼血尿,肾功能异常者为6例。9例肉眼血尿患儿中,2例持续肉眼血尿4~5周才转为镜下血尿,2例反复肉眼血尿分别至病程第8、10周才转为镜下血尿。11例肾病水平蛋白尿患儿中,7例符合肾病综合征(NS)诊断标准。12例患儿肾活检穿刺术取肾组织光镜结果示,系膜增生肾小球肾炎(GN)及毛细血管内增生性GN各为6例;电镜结果示,其均为系膜区、上皮下或内皮下电子致密物沉积,其中上皮下驼峰状电子致密物沉积为7例;免疫荧光结果示,其系膜区和毛细血管襻C3和免疫球蛋白(Ig)G沉积为主,或C3沉积为主。对6例患儿采取激素和(或)免疫抑制剂治疗,包括4例采用泼尼松口服治疗,2例采用甲泼尼龙联合环磷酰胺冲击治疗后,改泼尼松口服维持治疗;对另外6例患儿仅进行抗感染、对症支持治疗。随访4个月至3年,所有患儿肾功能正常,预后良好。结论对于急性期感染控制后,仍然表现为持续蛋白尿和(或)肾活检病理表现为显著系膜增生的不典型APSGN患儿,激素和(或)免疫抑制剂治疗,可能改善其预后。
Objective To explore clinical characteristics of atypical acute poststreptococcal glomerulonephritis(APSGN)in children.Methods From October 2015 to June 2019,a total of 12 children with atypical APSGN who were diagnosed and treated in Guangzhou Women and Children′s Medical Center were selected as research subjects.Their clinical case data were retrospectively analyzed,including clinical manifestations,laboratory examinations and renal biopsy histopathological results,treatment and follow-up results.The procedure followed in this study was consistent with the World Medical Association Declaration of Helsinki revised in 2013.Results All 12 cases of atypical APSGN had acute onset,among them 9 cases with macroscopic hematuria and 6 cases with renal dysfunction.There were 2 cases continued with macroscopic hematuria for 4 to 5 weeks and then turned into microscopic hematuria,and 2 cases with repeated macroscopic hematuria were not converted to microscopic hematuria until 8,10 weeks,respectively after the onset.Among 11 cases with nephrotic level proteinuria,there were 7 cases meeting the diagnostic criteria of nephrotic syndrome(NS).Light microscope results of renal biopsies of 12 children were 6 cases of mesangial hyperplasia glomerulonephritis(GN)and 6 cases of endocapillary hyperplasia GN.Results of renal biopsies by electron microscopic in those of above 12 cases were electron dense deposition in mesangial area,subepithelial or subendothelial in sight in all cases,and 7 cases had subcutaneous hump-like electron dense deposit.C3 combined with immunoglobulin(Ig)G deposition,or only C3 deposition were observed on mesangial region and capillary loop by immunofluorescence.Among 6 cases who were treated with steroids and(or)immunosuppressants,there were 4 cases with oral prednisone,and 2 cases with oral prednisone after pulse dose of methylprednisolone and cyclophosphamide.The other 6 cases only were treated with simple anti-infection treatment and symptomatic supporting treatment.Renal function and prognosis in those of 12 children all were normal and well after follow-up for 4 to 36 months.Conclusions After anti-infection treatment during acute stage,if children with APSGN are persistent with nephrotic level proteinuria and(or)clinicopathological findings with significant mesangial hyperplasia,steroids and(or)immunosuppressant treatment may improve their renal outcomes.
作者
邓会英
李颖杰
陈椰
杨华彬
钟发展
邓慧
Deng Huiying;Li Yingjie;Chen Ye;Yang Huabin;Zhong Fazhan;Deng Hui(Department of Nephrology,Guangzhou Women and Children′s Medical Center,Guangzhou 510210,Guangdong Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2021年第2期243-248,共6页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
广东省中医药局强省科研课题(20152042)
广州市科技攻关项目(201300000618,201904010476)。
关键词
链球菌感染
肾小球肾炎
肾病综合征
糖皮质激素类
免疫抑制剂
血尿
蛋白尿
儿童
Streptococcal infection
Glomerulonephritis
Nephrotic syndrome
Glucocorticoids
Immunosuppressive agents
Hematuria
Proteinuria
Child
