原发性干燥综合征合并肾脏损害的临床分析

Clinical analysis of primary Sjogren's syndrome patients with renal involvement

目的探讨原发性干燥综合征(PSS)肾脏损害的临床特点及预后。方法回顾性分析113例PSS合并肾脏损害患者的临床特征、肾小管功能、免疫学等检查资料。结果113例中89例为肾小管酸中毒(RTA),其中76例表现乏力,69例多饮、多尿及夜尿,57例骨痛,26例并有低钾性麻痹,9例出现肾性尿崩症;24例以肾小球病变为主,就诊时有36例肾功能不全;93例有明显高球蛋白血症。87例患者用激素或激素加免疫抑制剂治疗,其中36例随访0.5～10年肾功能恢复正常28例。结论PSS肾脏损害以RTA和肾小球肾炎为主,临床表现多样,激素加免疫抑制剂治疗可明显改善肾功能。

Objective To understand the impact of primary Sjogren＇s syndrome （PSS） on kidney by following up 113 patients with PSS in 1996 to 2006. Methods One hundred and thirteen patients of PSS with renal impairment were analyzed by routine, clinical features, tubular function and immunoassay. Results Among 113 PSS, 89 patients were diagnosed as renal tubular acidosis（RTA）, of whom 76 cases presented with Myastheina, 69 with polydipsia and polyuria, 57 with ostealgia, 9 with diabetesinsipidus, and 21 hypokalenic paralysis. Of 113 patients, 24 patients presented with glomerulonephritis,36 patients initially presented with renal impairment, significant elevation of IgG was noticed in 82.3%, 87 patients responded to the combination of steroid and immunosuppressors, and 28 had renal function completely recovered. Conclusion PSS patients with renal involvement developed varied syndrome, mainly tubular acidosis and glomerulonephritis. The combination of steroid and immunosuppressors can significantly improve th.e renal function of patients with PSS.