15例膜型狼疮肾炎的临床及病理特征

Clinical and Pathological Features of Membranous Lupus Nephritis in 15 Cases

目的:总结15例膜型狼疮肾炎(MLN)患者的临床及病理特征。方法:回顾分析15例经肾活检证实的MLN患者的临床及病理特征,并对随访的10倒患者采用Kaplan-Meier曲线进行肾存活率分析。结果:15例MLN患者,男性1例,女性14例,年龄35．4±11．2岁,其中Va型6例,Vb型9例。15例均有蛋白尿,>3．5 g／24 h 4例(26．7％,Va型2例,Vb型2倒);血尿3例(20．0％,均为Vb型),其中肉眼血尿1例(6．7％);高血压4例(26．7％,Va型1例,Vb型3例);甘油三酯高于正常10例(66．7％,Va型4例,Vb型6例);胆固醇高于正常6例(40．0％,Va型3例,Vb型3例);低C3血症8例(53．3％,Va型3例,Vb型5例);合并肾外表现13例(86．7％,Va型4例,Vb型9例)。病理方面15例MLN患者平均活动性指数为2．13±0．92(Va型1．67±1．03,Vb型2．44±0．73,P>0．05);平均慢性指数0．93±1．10(Va型0．67±1．21,Vb型1．11±1．05．P>0．05),血管累及3例(20．0％,Va型1例,Vb型2例)。10例获随访者,平均随访73．9±53．6月(29- 175月),以肾穿刺日为起点,10年肾存活率75％。结论:MLN好发于年轻女性,多数临床表现与特发性膜性肾病相似,肾病综合征较少见,肾存活率与文献报道相似。

Objective：To investigate the clinical and pathological features of Membranous lupus nephritis（MLN）. Methods：The medical data of patients（n= 15） with biopsy-proven MLN（class Va and Vb） were reviewed retrospectively. Kaplan-Meier curve was used to analysis renal survival rate. Results：All of 15 patients had proteinuria, but only 4（26.70/00, Va=2 vs Vb= 2） of them with urine protein over 3.5g/24h. 3 case （20.0%, class Vb） had hematuria. 4 cases（26.7%, Va=1 vs Vb=3） had hypertension. 10 cases（66. 7%, Va=4 vs Vb=6） had hypertriglyceridemia. 6 cases（40. 0%, Va=3 vs Vb=3） had hypercholesterolemia. 8 cases（53.3%, Va=3 vs Vb=5） had low complement component C3. 13 cases （86.7%, Va=4 vs Vb= 9） superimposed extrarenal manifestations. The pathologic active index was 2. 13± 0. 92（Va=1.67±1.03 vs Vb=2. 44±0. 73, P〉0.05） while chronic index was 0.93±1.10（Va=0. 67 ±1.21 vs Vb=1.11±1.05, P〉0. 05）. The mean follow-up was 73.9 ± 53.6 months and renal survival at 10 years was 75%. Conclusion：Conclusion： In our study, clinical and pathological manifestations of MLN have the features both of IMN and LN. Class Vb seems to be a little more severe than class Va with no statistical significance. Renal survival at 10 years was similar to other reported results.