狼疮性肾炎34例临床分析

Clinical analysis on 34 cases of lupus nephropathy

目的总结狼疮性肾炎的流行病学、临床表现、病理类型、治疗措施及疗效等方面的特点。方法选择我院2001年6月—2011年6月经过肾穿刺活检确诊的狼疮性肾炎患者，分析其年龄、性别等流行病学特点，并根据病理结果分组，对比分析各组临床表现、治疗措施、治疗效果。结果34例狼疮性肾炎患者，年龄17—58（34．9±11．8）岁，男3例，女31例。其中肾病综合征21例，主诉为水肿25例，病程20～30年。伴。肾功能不全7例（其中2例需要透析治疗）、合并感染12例、肝功能异常11例、高血压5例、脑出血1例、股骨头坏死1例、带状疱疹1例、精神症状1例、结核性胸膜炎1例。病理结果示I型3例（8．8％）、Ⅱ型3例（8．8％）、Ⅲ型9例（26．5％）、Ⅳ型13例（38．2％）、V型6例（17．6％）。非特异疗法1例（2．9％）、单纯激素10例（29．4％）、激素＋环磷酰胺13例（38．2％）、激素＋爱若华5例（14．7％）、激素＋雷公藤5例（14．7％），其中加用甲泼尼龙冲击治疗者10例（29．4％），血浆置换治疗者1例（2．9％）。治愈2例，好转28例，无效且因肝功异常停药1例，因经济原因放弃治疗2例，失访1例。结论狼疮性肾炎多见于女性，I临床表现及病理类型复杂多变，合并症多，治疗方案需要根据患者病情灵活确定。

Objective To summarize the epidemiological data, clinical presentations, pathological changes and therapy protocols on the patients with lupus nephropathy （LN）. Methods The LN patients from Jun. 2001 to Jun. 2011 in the database of renal puncture in our hospital were chosen. Their epidemiological data, such as age, sex, etc. were analyzed. They were divided into groups according to their pathological findings. The clinical presentations, therapeutic protocols and effects were analyzed and com- pared among the groups. Results There were totally 34 LN patients aged 17 - 58 （ 34.9 ± 11.8 ） years, including 3 males and 31 females. There were 21 eases of nephrotic syndrome and 25 cases of complaint of edema. Their duration was 20 - 30 years. There were 7 with renal insnffieiency （2 had to be given hemodialysis） , 12 with infection, 11 with abnormal liver function, 5 with hyper- tension, 1 with brain bleeding, 1 with femoral head necrosis, 1 with herpes zoster, 1 with mental disorders, and 1 case（s） with tu- berculous pleurisy. As for pathology, 3 cases （8.8%） were found as type I , 3 （8.8%） as type Ⅱ , 9 （26.5%） as type III, 13 （38.2%） as type IV, and 6 （ 17.6% ） as type V. About treatment, 1 ease （2.9%） was treated with non-special treatment, 10 （29.4%） with cortical steroid alone, 13 （38.2%） with cortical steroid plus cyclophosphamide （cytoxan, CTX）, 5 （14.7%） with cortical steroid plus leflunomide, 5 （14.7%） with tripterygium wilfdii multiglucoside （TWM）, 10 （29.4%） with high-dose methylprednisolone pulse therapy, 1 （2.9%） with plasma exchange. In the end, 2 cases were cured, 28 were improved, 1 nonef- fective （withdrew for abnormal liver function） , 2 withdrew for economic reason, and 1 was lost for follow-up. Conclusion LN is more common in females than in males, with complicated clinical manifestation and pathologic changes. Its treatment should be in- dividualized.