Adult Level Ⅲ Allergic Purpura Nephritis Rheumatism Syndrome And Clinical And Pathological Features And The Correlation Of Prognosis

Objective Level analysis of adultⅢallergic purpura nephritis rheumatism syndrome and clinical and pathological characteristics and prognosis,in order to provide Chinese and western medicine clinical workers for more in-depth and comprehensive understanding of HSPN.Methods Selection of hangzhou hospital during January 2009-December 2015 renal biopsy smears diagnosis of adult levelⅢpurpura nephritis(see international pediatric kidney disease collaboration center(ISKDC)for renal pathological grades)and long-term hospitalized patients in our department outpatient follow-up.Patient information collected in accordance with the uniform design table,including blood routine,urine routine,biochemical and immune indexes,24 h urine protein quantitative clinical indicators,and estimated glomerular filtration rate and pathological data(light microscopy,immunofluorescence,kidney pathological grading)and the scores of traditional Chinese medicine,rheumatism,follow-up information collection,analysis of adultⅢclass rheumatism of allergic purpura nephritis syndrome relevance to the clinical,pathological features and prognosis.Results 1.In 71 cases of adultⅢlevel in patients with allergic purpura nephritis,the male 34 cases,female 37 cases,the sex ratio of 0.92:1;The youngest was 16 years old,the largest was 68 years old,among which 51 cases were in the youth group(16-40 years old),accounting for 71.8%,which was the peak of the disease.The results indicated that there was no significant difference between age group and gender.Allergic purpura nephritis can occur all year round,with the onset peak in winter,accounting for31%,followed by autumn,accounting for 26.8%.Have clear incentive for a total of 26 cases,(36.6%),upper respiratory tract infection,a total of 11 cases,accounted for 15.5%,food allergies,a total of 5 cases,accounted for 7%,overwork,5 cases(7%),other incentives,5 cases(7%).All the patients in the course of the disease appeared typical skin purpura,14 patients with arthralgia,11 patients with gastrointestinal symptoms,including 3 cases with black,1 case of nausea and vomiting,a total of 3 cases with high blood pressure.2.The clinical manifestations of the 71 patients collected were all different degrees of hematuria,and the total of 24 hours of urine protein was more than 1g,accounting for 42.3%,of which 6 showed nephrotic syndrome.Serum creatinine increased by 14,accounting for19.7%,and the median of epi-egfr was 115.2 ml/(min·1.73m~2).3.This research collected cases according to ISKDC classⅢ,pathological classification is given priority to withⅢclass b,a total of 70 people,accounted for 98.6%,Ⅲclass a total of 1,1.4%;Immunofluorescence was mainly based on Ig A+C3 deposition,with a total of 42 patients combined with Ig M,with a total of 14 patients with Ig G+Ig M,7 with Ig G,5with C4 and 3 with C1q.The percentage of crescent bodies was less than 25%,with a total of55 persons,accounting for 77.5%,and the percentage of crescent bodies was 25%to 50%,accounting for 22.5%.There were a total of 49 people in the diffuse mesangial cells,accounting for 69 percent of the total population,and 20 in the light and moderate population,accounting for 28.2 percent of the total population.There were 36 patients in the glomerular capillary endothelial cells,accounting for 50.7 percent of the total number of patients,23 of whom were mildly hyperactive,accounting for 32.4 percent of the total population,4 of whom were moderately active,accounting for 5.6 percent of the total population,and 8persons with severe hyperplasia,accounting for 11.3 percent.4.In this study,there were 30 patients with nephrotic rheumatism syndrome,accounting for 42.3%,and non-rheumatism witnesses in 41 cases,accounting for 57.7%.Rheumatism group in clinic 24 hours urinary protein serum creatinine is not quantitative,TG,TC,rheumatism were significantly increased,and the mean arterial pressure,and no obvious difference was found between blood albumin,e GER,rheumatism group GAS in pathology(crescents percentage,MAO hyperplasia)than in rheumatism were significantly increased,and no obvious difference was found between GCS,TIS.Rheumatoid syndrome was positively correlated with serum creatinine,24-hour urinary protein quantification,TG,and crescent body percentage(P<0.05).5.As of the end of observation,the follow-up time was 35(6-101)months,including 45patients with complete remission in one year,14 in partial remission and 12 in unremission.After 2 years of follow-up,the total remission was 32,some of the remission was 10,and 8were not relieved.There were 43 people at the end of the study,17 of them were relieved and11 were not relieved.Single factor logistic regression analysis found that percentage crescents,capillary endothelial cell hyperplasia quantitative,EPI,24 hours urinary protein,serum albumin,hemoglobin,blood platelets,white blood cells,ALT,TC,Ig A,Ig E for risk factors affecting the prognosis,the multi-factor logistic regression analysis found that blood capillary endothelial cell hyperplasia after correction for the independent risk factors affecting prognosis,the prognosis of rheumatism and rheumatism group there is no statistical difference of looking at the end,the results show“rheumatism”is not the factors influencing prognosis.Conclusions 1.Adult levelⅢallergic purpura nephritis peaks of 16 to 40 years old,the winter in autumn and winter,the triggers more respiratory infections.Pathological classification is given priority to withⅢclass b,immunofluorescence,based on Ig A+Ig M+C3 deposits crescents percentage<25%,mild diffuse mesangial cells proliferation.2.Rheumatism is an important syndrome of HSPN,gradeⅢallergic purpura nephritis rheumatism group than in rheumatism clinical and pathological activities more and more heavy,characterized by 24 hours urinary protein quantitative,TG,TC,serum creatinine,GAS(crescents percentage,Capillary endothelial cell proliferation)is the rheumatism group increased more obviously,rheumatism symptom score and serum creatinine,24-hour urine protein quantitative,TG,crescent percentage were positively correlated.3.Combine traditional Chinese and western medicine effect after active treatment,remission rate is high,the multi-factor regression analysis suggests capillary endothelial cell hyperplasia is affecting the prognosis of adult levelⅢallergic purpura nephritis independent risk factors,prognosis of rheumatism and non rheumatic group no significant difference.