合并抗磷脂抗体相关性肾病慢性损伤的狼疮性肾炎39例临床分析

Clinical characteristics of thirty-nine cases of lupus nephritis with chronic histopathologic lesion of antiphospholipid antibody associated nephropathy

目的观察抗磷脂抗体相关性肾病(APLN)慢性肾组织病理损伤患者有别于狼疮性肾炎的临床特征。方法回顾性分析北京协和医院2000年后196例狼疮性肾炎患者的临床特点及预后。分为对照组:APL阴性且无APLN肾组织病理损伤(119例);研究组:合并APLN慢性肾组织病理损伤狼疮性肾炎患者(39例)。另38例为APL阴性合并APLN慢性损伤样病变患者。结果研究组与对照组患者的血压为138±29/85±19 vs 96±17 mmHg,肾活检时血肌酐为99±39 vs 91±42μmol/L,估算的肾小球滤过率(eGFR)为72.7±30.0 vs 87.8±24.0 mL/min.1.73 m2。随诊2年时血肌酐为93±26 vs 80±18μmol/L。研究组的血压(包括收缩压、平均动脉压)较对照组更高、eGFR更低。两因素重复测量方差分析表明,随诊2年后研究组患者的血肌酐改善程度明显差于对照组(P<0.05)。结论合并APLN慢性损伤的狼疮性肾炎患者的血压更高,eGFR更低,肾脏预后较差。

Objective To investigate the clinical characteristics that differentiate chronic histopathologic lesion of antiphospholipid antibody associated nephropathy （APLN） from lupus nephritis. Methods Data of 196 cases of lu- pus nephritis admitted to Peking Union Medical College Hospital was reviewed by retrospective analysis. 39 cases of lupus nephritis with chronic APLN were enrolled into the study group. The control group was composed of 119 cases of lupus nephritis without antiphospholipid antibody （APL） and APLN. Other 38 cases had negative APL and chro- nic lesion of APLN-Iike renal lesions. Results The blood pressure and the serum creatinine level at biopsy and two years later in the study group and the control group were 138 ± 29/85 ± 19 vs 96 ± 17 mmHg, 99 ± 39 vs 91± 42 μmoL/L and 93 ±26 vs 80 ± 18 μ mol/L, respectively. Estimated GFR （eGFR） at biopsy was 72. 7 ± 30. 0 vs 87. 8 =1= 24. 0 mL/min ± 1.73 m2. The blood pressure including systolic, mean arterial pressure and the eGFR at bi- opsy was significantly higher in the study group compared with the control group. Two-way repeated measures ANOVA showed the serum creatinine levels two years later in the study group decreased obviously less than that in the control group （P 〈 0. 05 ）. Conclusions Lupus nephritis patients with chronic histopathologic lesion of APLN had higher blood pressure, lower eGFR and relatively poor renal prognosis.