Ⅴ型狼疮性肾炎的临床及病理研究

The clinical and pathological aspects ofmembraneous lupus nephritis

本文回顾性地分析了４４例经肾活检诊断为Ⅴ型狼疮肾炎患者的临床及病理资料，并与５０例Ⅳ狼疮性肾炎患者进行比较。Ⅴ型狼疮肾炎患者中，男７例，女３８例，干均年龄２９．６±９．２岁，肾活检光镜下表现为纯膜性改变者１８例，非纯膜性改变者２６例。纯膜型与非纯膜狼疮性肾炎临床表现的比较表明、纯膜型组起病年龄大于非纯膜型组，肾外表现相对较少（关节受累率３８％∶７３％，血液系受累３３％∶５０％），纯膜型组血清肌酐升高患者的比例（０％）明显低于非纯膜型组（１１％），而非纯胰回组与Ⅳ型狼疮组的临床表现无显著差异：在肾病综合征比例、蛋白尿程度、镜下血尿比例上各组之间差异不显著，病理上除肾小球的基本改变外，纯膜型组小管间质改变较轻，较少伴有间质大量淋巴细胞浸润，而非纯膜型多伴系增殖及系膜插入，同时伴明显间质淋巴细胞浸润，血管周围炎细胞浸润，小管上皮细胞脱落、坏死、萎缩及慢性硬化性改变。免疫学检查表明纯膜型组患者高ＩｇＧ血症程度、补体Ｃ３，Ｃ４下降幅度以及血清Ａｎｔｉ－ＤｓＤＮＡ阳性滴度均不及非纯膜型组。通过以上结果的比较，我们认为Ⅴ型狼疮肾炎是一组不均一的疾病，至少可分成纯膜型与非纯膜型两大亚型，治疗上应区别对待。

In this study, we retrospectively com-pared the clinical and pathological aspects of44 SLE patients with rnembraneous lupusnephritis (V-LN) and 50 with diffuse prolif-erative lupus nephritis (Ⅳ-LN). All pa-tients meet the diagnostic criteria of ARA( 1982) for SLE. Based on the changes ofthe glomeruli, the 44 patients with V -LNwere subdivided into pure V -LN group (n=18) and non pure V -LN (n=26),withthe later having subendothelial immunode-posits or mesangial proliferation and/or cap-illary loop splitting. Results are shown inthe table below :V -LN itself is a heterogeneous groupthat at least can be devided into pure mem-braneous and non pure membraneous sub-groups. Pure V-LN has less severe renaland extrarenal manifestations, no GFR de-crease, and fewer changes of autoimmuneparameters .