非典型狼疮肾炎的临床和病理分析

Comparative study of clinical and pathological features of atypical lupus nephritis

目的探讨肾脏病理检查在非典型狼疮肾炎（LN）诊断中的意义。方法对28例非典型LN患者的临床和病理资料进行回顾性分析。结果28例患者肾活检前均未达到美国风湿病学会诊断标准，其中术前诊断为原发性肾病综合征21例，慢性。肾炎4例，无症状性血尿2例，元症状性蛋白尿1例；所有病例经肾活检确诊为LN，病理分型为：Ⅱ型3例，Ⅲ型4例，Ⅳ型21例，Ⅴ型7例，Ⅳ型＋Ⅴ型2例；临床表现为肾病综合征者肾脏病理分型多为Ⅴ型和Ⅳ型，慢性肾炎综合征者病理分型呈多样化，隐匿性肾炎综合征者病理分型主要为Ⅱ型和Ⅲ型。结论非典型LN临床表现无特异性，结合肾病理检查对非典型LN的诊断具有重要意义。

Objective To explore the clinical value of renal biopsy in the diagnosis of atypical lupus nephritis（LN）. Methods The clinical and renal pathological data of 28 cases with atypical LN were analyzed retrospectively. Results All 28 patients could not fulfill the ACR diagnostic criterion, misdiagnoscd as primary nephritic syndrome 21 cases ,chronic glomerulone-phritis syndrome 4 cases ,asymptomatic hematuria 2 cases and asymptomatic proteinuria 2 cases, all renal biopsy showed changes consistent to lupus nephritis,pathological types ：3 cases were classⅡ ,4 cases were class Ⅲ ,21 eases were class Ⅳ ,7 cases were class Ⅴ,2 cases was class Ⅳ ＋Ⅴ lupus nephritis,the clinical manifestations of nephritic syndrome were mostly pathological type Ⅳ and Ⅴ, the chronic glomerulonephritis syndrome showed diversification of pathological type, asymptomatic hematuria and/or proteinuria were mostly pathological type Ⅱ and Ⅲ. Conclusion Clinical manifestations of atypical LN is no specific and easy to be misdiagnosed. Renal biopsy has great value in the diagnosis of atypical LN.