狼疮性肾炎患者肾小管间质病变的临床意义

Clinical significance of renal tubulointerstitial lesions in patients with lupus nephritis

目的 :探讨狼疮性肾炎 (LN)患者肾小管间质病变及其临床意义。方法 :根据肾小管间质病变程度 (TIL)评分标准对 5 1例LN患者肾活检组织进行分级 ,并结合临床资料观察不同LN肾小管间质损害程度与活动指数(AI)、慢性指数 (CI)、病理分型、蛋白尿、肾功能及其他实验室检查结果之间的关系。结果 :5 1例LN患者伴有肾小管间质病变者 4 9例 (96 % )。对不同程度肾小管间质病变分级LN患者的AI、CI、TIL进行评分 ,Ⅱ级AI评分最高 ,与其他级别比较 ,差异有统计学意义 (P <0 .0 5 ) ;CI和TIL均以Ⅲ级评分最高 ,差异有统计学意义 (P <0 .0 1,P <0 .0 5 )。病理类型为Ⅳ型的LN患者肾小管间质病变程度显著高于其他病理类型。相关分析显示 ,LN患者TIL与AI、CI、Scr及Ccr水平相关 ,r分别为 0 .373(P <0 .0 1)、0 .813(P <0 .0 1)、0 .396 (P <0 .0 5 )、- 0 .4 76 (P <0 .0 5 ) ,与 2 4h尿蛋白定量等无相关性。结论 :LN肾小管间质病变与病理类型、肾功能损害程度、活动指数及慢性化程度具有一定的相关性 。

Aim:To study renal tubulointerstitial lesions (TIL) in patients with lupus nephritis(LN) and its clinical significance. Methods: A total of 51 patients with LN who had renal biopsy were scored and classified according to the TIL score criteria and clinical data. The relationship between the degree of TIL and active index(AI), chronic index(CI), pathological type, the level of proteinuria, renal function, and other laboratory data were investigated. Results: TIL was determined in 49 patients(96%). In different pathological types of LN, AI, CI, TIL were scored. AI score in patients with TIL grade Ⅱwas significant higher than that of other patients(P<0.05). CI and TIL score in patients with TIL grade Ⅲwere the highest which also had significance compared to other types(P<0.01, 0.05,respectively). The degree of TIL was more serious than that of other types. The degree of TIL was correlated with serum BUN, creatinine levels, and Ccr. The correlation coefficient was 0.373(P<0.01), 0.83(P<0.01), 0.396(P<0.05),-0.476(P<0.05),respectively. There had no significant correlation between TIL and the total amount of 24 h urinary protein. Conclusion: The degree of TIL in LN is correlated with its pathological type, the degree of renal dysfunction, AI and CI, and it also has an effect on the prognosis of the LN patients.