类风湿性关节炎的肾脏损害与免疫学异常

IMMUNOLOGIC CHANGES AND RENAL LESIONS IN RHEUMATOID ARTHRITIS

目的：探讨类风湿性关节炎（ＲＡ）肾脏损害的特点以及ＲＡ免疫学异常与肾脏受累的关系。方法：分析１１例ＲＡ患者的临床表现，肾活检病理资料及血清免疫学、血液生化及尿液分析等检查结果。结果：有明显肾损害临床表现者仅３例，但全部病例肾活检均有病理改变，组织学类型以系膜增生性肾炎为主。９例血清ＩｇＭ型类风湿因子（ＩｇＭ－ＲＦ）阳性，滴定度１∶２０～１∶３２０。ＩｇＭ－ＲＦ１∶４０以上阳性者，免疫荧光检查均显示系膜区和（或）血管袢有免疫球蛋白及补体成份沉积。结论：本组ＲＡ患者肾脏损害发生率高达１００％，系膜增生是其主要的病理改变，大部分病例肾脏病变与ＲＡ自身免疫学异常有关。

OBJECTIVE To evaluated the characteristics of renal involvement and the relations between immunologic changes and renal biopsy findings in patients with rheumatoid arthritis(RA).METHODOLOGY Eleven RA patients(male/femal:1/10, aged 29～65years) were included, who received intermittently nonsteroid antiinflammatory drugs, but never any gold salts or Dpenicillamine. Serum immunologic investigation and renal biopsy were performed in all the eleven patients. RESULTS In the eleven RA patients, three presented with overt renal involvement manifested as isolated proteinuria, proteinuria plus hematuria and nephrotic syndrome with or without renal insufficiency. Mesangial proliferative lesion was the most common lesion, with mesangial IgA deposition in one and IgM deposition in three. Membranous nephropathy was found in two, with one had mesangial IgA deposition. Chronic interstitial nephritis was found in one patient. There were nine patients positive for IgM rheumatoid factor (RF). Seven patients with high titer serum IgMRF showed glomerular immunoglobulin deposition as compared to those without.(P<001, χ2 test)CONCLUSION Patients with RA are all complicated with renal involvement that manifested clinically in 27%(3/11) of the patients. Mesangial proliferation is the most frequent lesion. Membranous nephropathy and chronic interstitial nephritis are also found. The renal lesion in RA patients may be linked with the immuoabnormality of RA itself in addition to the effects of the treatments.