59例狼疮性肾炎临床病理资料分析

Analysis on cilincal pathological data of 59 cases of lupus nephritis

目的:探讨狼疮性肾炎(LN)的临床表现、病理类型与免疫学指标的相互联系。方法:回顾性分析2003年10月至2009年12月东南大学附属中大医院肾内科肾活检中59例狼疮性肾炎(LN)的临床特征、病理类型与免疫学指标的特点及关联。结果:本组患者中,男8例,女51例,男女比为1∶6.3。肾活检时男平均年龄为(28.6±10.6)岁,女平均年龄为(37.3±10.3)岁。本组59例LN肾活检中,以Ⅳ型最多,占55.9%,依次为Ⅲ型(11.9%)、Ⅴ型(10.2%)、Ⅱ型(8.4%)、Ⅳ+Ⅴ型(8.4%)及Ⅲ+Ⅴ型(5.1%)。隐匿性肾炎、肾炎综合征型以Ⅱ、Ⅲ型为主;肾病综合征型者以Ⅳ、Ⅴ、Ⅳ+Ⅴ及Ⅲ+Ⅴ型为主;肾功能不全型LN,则以Ⅳ、Ⅳ+Ⅴ为主,与其它类型比较,差异有显著性(P<0.05)。Ⅳ型LN患者血尿发生率较高,而Ⅳ、Ⅳ+Ⅴ型LN贫血发生率显著高于其它组(P<0.05)。Ⅳ、Ⅴ及Ⅳ+Ⅴ型LN高血压的发生率显著高于Ⅱ型及Ⅲ型(P<0.05)。Ⅳ型AI评分最高,与其它类型比较,差异有显著性(P<0.05)。免疫学指标中,以血补体C3水平下降、抗dsDNA及ANA阳性发生率较其它免疫学指标高,Ⅳ型LN血补体C3水平降低最为明显,与其它类型比较,差异有显著性(P<0.05)。结论:LN病理类型与临床资料间有一定对应关系,因此根据临床资料有时可以推测病理类型,对于未开展肾活检的医院有一定的指导治疗作用。

Objective： To survey the epidemiology,pathological category and clinical manifestation of lupus nephritis（LN） and to investigate the interrelationship between clinical features and pathological category.Methods： The clinicopathological data of 59 cases diagnosed as LN undergoing renal biopsy were obtained.The patients came from Department of Nephropathy,the Affiliated Zhongda Hospital to Southeast University from October 2003 to December 2009.The distribution of clinical features,the distribution of pathological patterns,the interrelationship between clinical features,pathological patterns and immunne index were analyzed.Results： There were 8 males and 51 females,and the ratio of male to female was 1∶6.3.The mean age of the male patients was（28.6±10.6） years old and female patients was（37.3±10.3） years old.In the 59 cases,type Ⅳ LN was the most frequent type（55.9%）,followed by type Ⅲ（11.9%）,Ⅴ（10.2%）,Ⅱ（8.4%）,Ⅳ plus Ⅴ（8.4%） and Ⅲ plus Ⅴ（5.1%） of LN.The patients clinically manifesting latent glomerulonephritis or nephritic syndrome were mainly type II or Ⅲ of LN,nephrotic syndrome were mostly type Ⅳ,Ⅴ,Ⅳ plus Ⅴ or Ⅲ plus Ⅴ of LN.Cases with clinical diagnose of renal failure were mainly type Ⅳor Ⅳ plusⅤ of LN,which had a significance compared with oter types of LN（P0.05）.The patients of type Ⅳ of LN were mainly hematuria.It was the most frequency of anemia in type Ⅳ or Ⅳ plusⅤ of LN than in other types of LN（P0.05）.The prevalence of hypertension was significantly increased in types Ⅳ,Ⅴor Ⅳ plus Ⅴ of LN than types Ⅱ and Ⅲ of LN（P0.05）.Active index of type Ⅳ of LN was mostly higher than other types of LN（P0.05）.Among immune index,the decreased levels of complement C3,higher levels of anti-dsDNA and anti-nuclear antibody in serum were mostly observed.Furthermore,the level of complement C3 in type IV of LN was significantly decreased than other types of LN（P0.05）.Conclusion： The results suggest there exists a corresponding relationship between the pathological patterns and clinical manifestations of LN.Based on the clinical data of LN,speculation of the pathological pattern of LN can be drawn,which helps a lot in the hospitals where renal biopsy technique has not developed.