抗心磷脂抗体与狼疮肾炎肾小球微血栓形成的临床研究

Correlation study of anticardiolipin antibody and glomerular microthrombi in lupus nephritis

目的探讨系统性红斑狼疮（SLE）患者抗心磷脂抗体（ACL）与狼疮。肾炎肾小球微血栓（GMT）形成的相关性，并探讨与狼疮肾炎GMT形成相关的临床因素。方法回顾性分析2005年1月至2010年10月中日友好医院收治的狼疮肾炎患者的年龄、性别、肾脏及肾外表现等因素对狼疮肾炎伴GMT形成的影响。酶联免疫吸附试验（ELISA）法检测患者血清抗心磷脂抗体（ACL）水平，采用，检验和Logistic回归模型进行分析。结果①126例狼疮肾炎患者纳入研究，其中38例伴发GMT形成，88例无GMT形成，通过对照研究，狼疮肾炎伴GMT形成组系统性红斑狼疮疾病活动指数（SLEDAI）、尿蛋白定量（24h）、血清肌酐、血清尿素氮的水平、抗双链DNA（dsDNA）抗体阳性、严重高血压、贫血和血小板减少、关节炎的发生率都较狼疮肾炎无GMT形成组高（P均〈0．01）。Logistic多因素回归分析显示SLEDAI评分[比值比（OR）=2．486，95％可信区间（CI）1．678-3．684，P=0．000]、贫血（OR=4．628，95％CI1．045-20．496，P=0．044）与狼疮肾炎伴发GMT形成相关。②肾活检病理结果显示，GMT在狼疮肾炎中的发生率为30．2％（38例），秩和分析发现伴GMT形成的狼疮肾炎患者肾脏病理损伤重（P=0．012），狼疮肾炎无GMT与狼疮肾炎伴GMT形成2组肾脏病理分型Ⅳ型狼疮肾炎的比例分别为38％与76％，HI型狼疮肾炎的比例分别为31％与8％。③狼疮。肾炎伴GMT形成组ACL的阳性率较狼疮肾炎无GMT形成组高，分别为61％（23例）和36％（15例），差异有统计学意义（P=O．018）。结论GMT形成在狼疮肾炎中并不罕见，SLEDAI、贫血、ACL阳性与GMT形成相关，狼疮肾炎伴发GMT患者肾脏病理损伤重。

Objective To explore the correlation of anticardiolipin antibody （ACL） and lupus nephritis （LN） glomerular microthrombi （GMT） in patients with systemic lupus erythematosus （SLE） and to analyze their clinical manifestations and renal pathological characteristics. Methods The clinical data of 126 LN patients treated at our hospital between January 2005 and October 2010 were retrospectively reviewed. The factors, including age, gender,the clinical manifestations in and outside of kidney were evaluated by multivariate Logistic regression analysis. Enzyme-linked immunosorbent assay （ELISA） was used to test the serum levels of ACL in all patients. Statistical analysis was conducted using X^2 test and Logistic regression. Results ①All 126 patients were investigated. Thirty-eight LN patients had GMT. When compared with the LN-non-GMT group, the SLE disease activity index （SLEDAI）, urinary protein quantity （24 h）, serum ereatinine, serum urea nitrogen, anti-dsDNA antibody （＋）, the incidence of severe hypertension, anemia, thromboeytopenia, arthritis were higher in the LN-GMT group （P〈0.01）. Logistic regression analysis showed that SLEDAI （OR= 2.486, 95%CI 1.678-3.684, P=-0.000）, anemia （OR=4.628, 95%Cl 1.045-20.496, P=-0.044） were correlated with GMT; ②The pathologic results of renal biopsy showed that GMT had an incidence of 30.2% （n=38） in LN. As compared with the LN-non-GMT group, Wileoxon test showed that the LN-GMT group suffered more severe greater renal pathological injuries （P=0.012）. The pathological types of LN-non-GMT and LN-GMT groups were as follows： type Ⅳ （38% vs 76%） and type Ⅲ （31% vs 8%）; ③ The positive rate of ACL was higher in the LN-GMT group than that in the LN-non-GMT group （n=23, 61% vs n=15, 36% ）. The differences were statistically significant （P=0.018）. Conclusion GMT is not rare in LN. SLEDAI, anemia and positive ACL are correlated with GMT, LN patients with concurrent GMT have more severe renal pathologicalchanges.