儿童IgA血管炎肾炎伴高凝状态的尿蛋白和肾脏病理特征分析

Urinary protein and renal pathological features in children with immunoglobulin A vasculitis with nephritis and hypercoagulability

摘要:

目的 探讨高凝状态与IgA血管炎肾炎（immunoglobulin A vasculitis with nephritis, IgAVN）患儿尿蛋白和肾脏病理损伤之间的关系。方法 根据凝血功能结果，将349例IgAV患儿分为高凝组（52例）和非高凝组（297例），比较两组间尿蛋白和肾脏病理特征，并分析IgAVN患儿高凝状态形成的影响因素。结果 高凝组患儿尿红细胞计数、24 h尿蛋白定量、尿蛋白/肌酐、尿免疫球蛋白G/肌酐、尿N-乙酰β-D-氨基葡萄糖苷酶水平高于非高凝组（P<0.05）；高凝组患儿肾脏病理分级为Ⅲ~Ⅳ级、弥漫性系膜增生、毛细血管内皮细胞增生、肾小球新月体形成>25%比例高于非高凝组（P<0.05）。多因素logistic回归分析结果显示，毛细血管内皮细胞增生、肾小球新月体形成>25%是IgAVN患儿高凝状态形成的影响因素（P<0.05）。结论 伴高凝状态IgAVN患儿的肾损伤更为严重，肾小球新月体形成>25%和毛细血管内皮细胞增生是进一步加重IgAVN高凝状态的重要因素。

Abstract:

Objective To study the association of hypercoagulability with urinary protein and renal pathological damage in children with immunoglobulin A vasculitis with nephritis (IgAVN).Methods Based on the results of coagulation function, 349 children with IgAVN were divided into a hypercoagulability group consisting of 52 children and a non-hypercoagulability group consisting of 297 children. Urinary protein and renal pathological features were compared between the two groups, and the factors influencing the formation of hypercoagulability in children with IgAVN were analyzed.Results Compared with the non-hypercoagulability group, the hypercoagulability group had significantly higher levels of urinary erythrocyte count, 24-hour urinary protein, urinary protein/creatinine, urinary immunoglobulin G/creatinine, and urinary N-acetyl-β-D-glucosaminidase (P<0.05). The hypercoagulability group also had a significantly higher proportion of children with a renal pathological grade of III-IV, diffuse mesangial proliferation, capillary endothelial cell proliferation, or >25% crescent formation (P<0.05). The multivariate logistic regression analysis showed that capillary endothelial cell proliferation and glomerular crescent formation >25% were associated with the formation of hypercoagulability in children with IgAVN (P<0.05).Conclusions The renal injury in IgAVN children with hypercoagulability is more severe, with greater than 25% crescent formation and increased proliferation of glomerular endothelial cells being important contributing factors that exacerbate the hypercoagulable state in IgAVN.