老年狼疮性肾炎26例临床和病理分析

The clinical and pathological features about renal damage of lupus nephritis in the aged

目的探讨老年狼疮肾炎（LN）肾损害的临床和病理特点。方法选择我院收治的老年LN患者26例（发病年龄≥50岁），随机抽取同期住院的50例中青年LN患者（发病年龄〈50岁）作为对照组，比较分析两组患者的临床与肾病理特点。结果老年组男性发病率和误诊率均较对照组增高，确诊时间较对照组延长。老年组血尿发生率和24h尿蛋白排泄量均低于对照组，但高血压发生率和血肌酐水平高于中青年组；肾脏病理类型分布老年组与中青年组的差异无统计学意义，以Ⅳ型、V型多见，临床上多表现为肾炎综合征和’肾病综合征；老年组血清抗核抗体水平及特异性抗体（抗双链DNA、抗Sm抗体）阳性率偏低。在治疗上起始激素用量明显低于中青年组，近期疗效相仿，但副作用发生率高于中青年组。结论老年LN患者男性发病比例增高、临床表现不典型、血清特异性抗体阳性率低，容易误诊和漏诊：老年LN患者血尿、蛋白尿水平低于中青年组，但血肌酐显著增高；治疗上对于老年LN患者应严格掌握激素使用指征及剂量，密切监测副作用，注意并发症的综合治疗。

Objective To investigate the clinical and pathological features about renal damage of lupus nephritis （LN） in the aged, aiming to get better clinical guidance. Methods The clinical files of 26 elderly patients with lupus cystitis whose ages of onset were oTder than 50, treated at Hangzhou traditional Chinese medical hospital were reviewed to performe a retrospective study, over a period from January 2003 to October 2010.Another 50 middle-youth-aged patients whose ages of occurrence were younger than 50, were chosen to be a control group. Clinical manifestations, and pathological features of renal damage were analyzed. Results The old group was more difficult to make diagnosis in time and more easily misdiagnosed with a higher incidence of this disease in males. The elderly presented less frequently with hematuria and greater excretion of urinary protein,but more frequently with hypertension and higher serum creatinine. There was no obvious difference in renal pathological type distribution between the two groups. IV and V type were seem more, whose clinical performance were generally nephritis syndrome and nephrotic syndrome. It showed that the positive rates of specific antibody（anti-dsDNA, anti-Sin）were lower in elderly. Meanwhile, about treatment, the dosage of glucocorticoid was lower but with higher side effects in elderly. There was no obvious difference between the two groups in the short-term therapeutic effectiveness. Conclusion LN in elderly, is occult in onset and of lower incidence of typical clinical manifestations and specific antibodies, resulting in misdiagnosis easily. The incidences of hematuria and mass proteinuria were lower than middle-youth-aged group. But the level of serum creatinine was increased in elderly. The indi- cations and dosage of the hormone and immunosuppressive agents should be strictly mastered because of the poorer constitution, the more basic diseases and more obvious side effects of the patients with LN in elderly. Once the complications occurred, it is important to adopt the comprehensive treatment.