儿童狼疮性肾炎24例临床特点

Clinical Features of 24 Cases of Lupus Nephritis in Children

目的回顾分析系统性红斑狼疮(SLE)患儿临床资料,探讨儿童狼疮性肾炎(LN)的临床特点。方法收集2003年1月-2008年12月住院治疗符合美国风湿病学会关于SLE及其肾损害诊断标准、年龄小于18岁的SLE患儿资料,比较LN与非LN患儿临床表现及实验室指标,并对部分患儿的肾活检结果进行分析。应用SPSS16.0软件进行统计学分析。结果46例SLE儿童中,并LN者24例(LN组),发生率为52.2%,非LN组22例。LN与非LN在民族构成、性别构成、年龄、病程方面差异均无统计学意义(Pa>0.05);二组肾外首发症状15项指标阳性率差异均无统计学意义(Pa>0.05);二组ALT升高,血清补体C3降低,抗核抗体(ANA)>180,抗ds-DNA阳性,抗Sm阳性等指标阳性率差异均有统计学意义(Pa<0.05);余各项指标差异均无统计学意义(Pa>0.05)。结论在儿童SLE中,LN发生率高;其发生的高危因素是血浆ds-DNA抗体、抗Sm,ANA升高和补体降低;该病临床表现多样,易误诊。

Objeetive To analyze retrospeotively clinical data of systemic lupus erythematosus （SLE） in children, and investigate the clinical characteristics of lupus nephritis （LN） in children. Methods A retrospective study of 46 children with SLE from Jan. 2003 to Dec. 2008 was conducted,all of the childen younger than 18 years of age meet the diagnostic criteria of the American College of Rheumatology on SLE and renal damage. Twenty - four children with LN and 22 cases without LN were analyzed, the parameters about clinical symptoms and laboratory examination of the 2 groups were compared（ of them, 6 cases had integrated renal pathological data）. Results The prevalence of LN was 52.2%. Compared with non- LN group, there was statistically significant difference in the parameters such as ALT, C3, antiANA 〉 1 ： 80, anti - ds - DNA, anti - Sm （ Pa 〉 0.05 ） , while the 2 groups showed no significant difference in clinical manifestations and the other parameters（P, 〉 0.05 ）. Conclusions The prevalence of LN is high in children. Anti - ds - DNA and hypoeomplementemia, anti - ANA 〉 1 ： 80, anti - ds - DNA, anti -Sm and lower C3 , are high risk factors in the development of LN. The manifestations were various and misdiagnosis at the early stage was not uncommon.