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  本文關(guān)鍵詞： 兒童 腎活檢 臨床 病理 并發(fā)癥　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的總結(jié)腎穿刺活檢患兒的臨床與病理特點,了解腎活檢的并發(fā)癥、適應癥及禁忌癥,探討臨床與病理之間的關(guān)系,為臨床醫(yī)師提供幫助。方法收集2005年1月至2016年1月在廣西醫(yī)科大學第一附屬醫(yī)院兒科住院并成功進行腎穿刺活檢196例患兒的臨床和病理資料,回顧性分析其臨床及病理特點。結(jié)果(1)196例腎活檢患兒男123例(62.8%),女73例(37.2%),男:女=1.68:1,平均年齡10.81±2.41歲(4歲7月~15歲11月),其中原發(fā)性腎小球疾病(PGD)120例(61.2%),繼發(fā)性腎小球疾病(SGD)74例(37.8%),遺傳性腎病2例(1.0%)。(2)臨床表現(xiàn):PGD中最常見為腎病綜合征(96例,80.0%),其次為血尿合并蛋白尿(10例,8.3%)、孤立性血尿(6例,5%);SGD中最常見為腎病綜合征(40例,54.1%),其次為血尿合并蛋白尿(21例,28.4%)、孤立性蛋白尿(10例,13.5%)。(3)病理類型:PGD最常見為IgA腎病(32例,26.7%),其次為系膜增生性腎小球腎炎(25例,20.8%)、腎小球輕微病變(24例,20.0%);SGD中,狼瘡性腎炎(LN)32例(43.2%),最常見為IV型(13例,40.6%),過敏性紫癜性腎炎(HSPN)32例(43.2%),最常見為IIb級(13例,40.6%),乙型肝炎病毒相關(guān)性腎炎(HBV-GN)10例(13.5%),最常見為膜性腎病(8例,80.0%)。(4)相關(guān)性分析:PGD的臨床與病理之間具有一定相關(guān)性,臨床表現(xiàn)為腎病綜合征的其病理主要為腎小球輕微病變、系膜增生性腎小球腎炎及IgA腎病,而臨床表現(xiàn)為血尿和(或)蛋白尿的其病理主要是IgAN。SGD的臨床與病理之間無顯著相關(guān)性。(5)腎活檢并發(fā)癥:出現(xiàn)腎活檢并發(fā)癥71例(36.2%),最常見為腎周血腫(51例,26.0%),其次為肉眼血尿、肉眼血尿合并腎周血腫(均為8例,4.1%)。結(jié)論(1)兒童超聲引導下腎臟穿刺活檢術(shù)成功率高,操作簡便,腎臟損傷小。(2)本組資料中,兒童腎小球疾病以腎病綜合征及血尿合并蛋白尿為主要表現(xiàn),其病理類型多種多樣。(3)兒童SGD常見為LN、HSPN和HBV-GN,其臨床表現(xiàn)、病理類型和病理分級呈現(xiàn)多樣性,臨床與病理之間無一一對應關(guān)系。(4)兒童腎穿刺活檢術(shù)并發(fā)癥少,以出血性并發(fā)癥常見,未出現(xiàn)嚴重并發(fā)癥。
[Abstract]:Objective to summarize the clinical and pathological features of renal biopsy in children, to understand the complications, indications and contraindications of renal biopsy, and to explore the relationship between clinical and pathological. Methods Clinical and pathological data of 196 children with renal biopsy were collected from January 2005 to January 2016 in Department of Pediatrics, first affiliated Hospital of Guangxi Medical University. . The clinical and pathological features were retrospectively analyzed. Results there were 123 males (62.8%) and 73 females (37.2%), male: female: 1.68: 1. The mean age was 10.81 鹵2.41 years old, 4 years old, July to 15 years old, November years old, of which 120 cases of primary glomerular disease were diagnosed as PGD and 61.2%). Secondary glomerular disease (SGD) 74 cases (37. 8%), hereditary nephropathy (2 cases) 1. 0% PGD (n = 96): nephrotic syndrome (n = 96). 80.0%, followed by hematuria with proteinuria in 10 cases, and isolated hematuria in 6 cases. The most common cases in SGD were nephrotic syndrome (n = 40), hematuria with proteinuria (n = 21) and solitary proteinuria (n = 10). The most common pathological type was IgA nephropathy (n = 32), followed by Mesangial proliferative glomerulonephritis (n = 25). There were 24 cases with slight glomerular lesions. In SGD, 32 cases of lupus nephritis (LNN) were found to be 43.2%, the most common were type IV (n = 13) and Henoch-Schonlein purpura nephritis (n = 32). The most common cases were IIb grade (n = 13), HBV-GNN (n = 10) and membranous nephropathy (n = 8). There was a certain correlation between the clinical and pathological changes of PGD, and the pathological features of the nephrotic syndrome were mainly slight glomerular lesions. Mesangial proliferative glomerulonephritis and IgA nephropathy. However, the pathology of hematuria and / or proteinuria was mainly related to the clinicopathology of IgAN.SGD. There was no significant correlation between the clinicopathology and the clinicopathology. There were 71 cases of renal biopsy complications (. 36.2). The most common hematoma was perirenal hematoma in 51 cases (26. 0%), followed by naked hematuria (8 cases), naked hematuria (8 cases) and perirenal hematoma (8 cases). Conclusion Ultrasound-guided renal biopsy in children has high success rate, simple operation and small renal injury. Nephrotic syndrome and hematuria with proteinuria are the main manifestations of glomerular disease in children. The pathological types of glomerular disease in children are varied. The SGD in children is usually LNN HSPN and HBV-GNN. The pathological types and pathological grades showed diversity, and there was no one-to-one correspondence between clinical and pathological. 4) the complications of renal puncture biopsy in children were few, and hemorrhagic complications were common, but no serious complications.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.9

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