狼疮性肾炎130例临床和病理分析

Analysis on Clinical and Pathological of 130 Cases with Lupus Nephritis

目的探讨不同类型狼疮性肾炎患者的临床和病理特点。方法回顾性分析狼疮性肾炎患者128例病例资料,在B超下行肾活检,进行病理分型。标本分别做直接免疫荧光、光镜和电镜检查,并对患者的临床表现进行分析。结果 128例患者中,以Ⅳ型最多62例占48.44%;其次是V型和II型,分别为21例、12例,占16.41%和9.38%,III型、III+V型和Ⅳ+V型相对少见,分别为13例、8例、7例,占10.16%、6.25%和5.47%。Ⅱ型多表现为隐匿性肾炎;Ⅲ型多表现为肾炎综合征;IV型和V型多表现为肾病综合征。Ⅱ型荧光沉积部位以系膜区(Ms)为主,V型和Ⅳ+V型荧光沉积部位以肾小球毛细血管壁(GCW)为主,Ⅲ型和Ⅳ型荧光沉积部位以(GCW+MS)为主。Ⅳ型和Ⅳ型的AI和CI评分要高于其他类型。结论不同类型狼疮性肾炎的临床表现和病理检查均有一定的特点,这对于狼疮性肾炎的分型诊断临床治疗和预后判断具有指导意义。

Objectire To explore the clinical and pathologic features with different types of lupus nephritis patients.Methods Retrospective analysis 128 cases material of patients with lupus nephritis,renal biopsy under B-sonography downlink,pathological type.Specimens were directly immunofluorescence,light and electron microscopy examination,and the clinical manifestations of patients were analyzed.Results Ⅳ type is the most of 48.44% in 128 patients,sixty-two cases,Second is the V and II type,respectively 21 and 12 cases the rates is 16.41% and 9.38%,type III and V type V ＋ Ⅳ and relatively rare.respectively13 cases,8 cases,7 cases of.the rates is 6.25% 10.16%,and 5.47%.Latent nephritis is the most in Ⅱ type,nephritis syndrome is the most in Ⅲ type, nephrotic syndrome is the most in V type and Ⅳ type.The deposition area with fluorescent of theⅡ type is almost in mesangial （MS）.The deposition area with fluorescent of the V and Ⅳ＋V is almost in glomerular capillary wall （GCW）,The deposition area with fluorescent of the Ⅲ and Ⅳ type is almost in glomerular capillary wall AND mesangial （GCW＋MS）.the AI rate of III and Ⅳ type is higher than other types.Conclusion The clinical and pathological examination of different types with lupus nephritis, this has certain characteristics of lupus nephritis for clinical diagnosis, classification and the prognostic significance.