狼疮性肾炎的临床与免疫学特征分析

Clinical and immunological features of Chinese patients with lupus nephritis

目的:分析180例狼疮性肾炎(lupus nephritis,LN)的临床特点、肾脏病理类型和免疫学异常的联系。方法:1995年8月～2009年12月在我科住院的经临床检查及肾活检病理诊断为LN的患者共180例。肾活检病理类型按照2003年ISN/RPS分型方案,临床资料来自病史记载,实验室指标取自首次肾活检时的检查结果。回顾性分析患者一般资料、病理类型分布、各病理类型的临床和免疫学特征。结果:180例患者LN患者肾外脏器损害临床表现中,以发热症状最常见,共124例(68.9%);合并高血压者56例(31.1%),血肌酐升高者(Scr≥133umol/l)47例(26.1%)。病理以Ⅳ型最常见,共76例(42.2%);Ⅱ型70例(38.9%),Ⅲ型16例(8.9%),Ⅴ型12例(6.7%),Ⅰ型4例(2.2%),Ⅴ型2例(1.1%)。LN不同肾脏病理类型的肾外表现中,Ⅱ型患者发热、皮肤粘膜损害发生率显著高于其它病理类型(P<0.05),Ⅳ型浆膜炎发生率高于其它病理类型(P<0.05)。血清ANA阳性与发热、低C3血症相关(P<0.05),血清A-sm阳性与皮肤粘膜损害相关(P<0.05),血清A-dsDNA阳性与贫血显著相关(P<0.05)。结论:本组LN病理类型以Ⅳ型为主,Ⅱ型患者肾外表现较为突出,以发热、关节痛、皮肤损害等多见,LN不同病理类型具有一定的临床和免疫学特征,反映了不同的免疫发病机制。

Objective：To analyze the clinical and immunological features of 180 Chinese patients with lupus nephritis.Methodology：180 LN patients in Urumqi general Hospital from 1995 to 2009 were included in this study.All patients had renal biopsy.The histological classifications were categorized according to 2003 ISN /RPS classification.Results：Fever is the most common extra renal manifestations（69.8%）,The proportion of hypertension and renal insufficiency is 31.1%,26.1%respectively.The renal histological classes showed classⅡ（38.9%）,Ⅲ（8.9%）,Ⅳ（42.2%）,Ⅴ（1.1%）.The incidence of extra renal manifestations including skin lesion,fever were more common in classⅡthan that in other types.Meanwhile, The serositis is higher in classⅣthan that in other types.positive ANA was relative with fever,low C3（P0.05）,positive anti - sm antibody was higher in patients with skin lesion,and positive anti - dsDN A antibody was more frequent in patients with anemia（P0.05）.Conclusion：Lupus nephritis classⅣwas the most common type in this study.The correlation between histological class and clinical immunological features might be associated with unique immunopathogenesis.