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Ⅳ型狼疮性肾炎不同病理亚型的临床病理与预后 被引量:6

Differences between Class ⅣS and ⅣG in patients with lupus nephritis
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摘要 目的:探讨弥漫增生性狼疮性肾炎不同病理亚型[弥漫性节段型(ⅣS型)和球型(ⅣG型)]患者临床病理特点及预后。方法:157例经肾活检病理明确诊断的Ⅳ型LN患者,根据肾小球病理改变分为ⅣS组(n=42)和ⅣG组(n=115)。诱导治疗采用激素联合间断环磷酰胺静脉冲击治疗(IVCY)或激素联合吗替麦考酚酯(MMF)。回顾性分析两组患者临床、病理及预后的差异。结果:ⅣS组和ⅣG组基线肾脏损害指标无差异。ⅣS组血清补体C3(0.493 g/L vs 0.355 g/L,P<0.01)和C4水平(0.111 g/L vs 0.065 g/L,P<0.01)均显著高于ⅣG组,补体C4降低发生率明显低于ⅣG组(50.0%vs 80.9%,P<0.01)。肾活检组织学观察证实,ⅣS组白金耳(0vs 42.6%,P<0.01)和微血栓(2.4%vs 36.5%,P<0.01)比例显著低于ⅣG组。ⅣS组患者6个月完全缓解(CR)率显著低于ⅣG组(33.3%vs 53.0%,P=0.029)。其中,ⅣS+IVCY组6个月CR率显著低于ⅣG+IVCY组(18.8%vs 52.7%,P=0.016)。ⅣS组10年无血清肌酐倍增或进展至终末期肾病患者生存率显著低于ⅣG组(70.4%vs 97.1%,P=0.015)。结论:ⅣS型LN肾小球呈现"寡免疫复合物沉积"特点,传统免疫抑制治疗的缓解率及肾脏远期预后均较ⅣG型LN差,提示Ⅳ型LN不同亚型可能存在不同的发病机制不同。 Objective:This study aimed to determine the differences in clinicopathological features and outcome between segmental and global LN. Methodology:Forty-two patients with biopsy-proven segmental LN (Class IV S group) and 115 with global LN (Class IV G group) were identified and retrospectively analyzed. Classification criteria were modified in our study. Class IV S LN was defined as t〉 50% of glomeruli manifesting crescents or fibrinoid necrosis, and the uninvolved glomerular and capillary loop were normal. Class IVG LN was defined as 〉150% of the glomeruli manifested as endocapillary proliferation involving the whole glomerular without fibrinoid necrosis or crescent. Results: ( 1 ) Class IV S had significantly higher complement C3 ( 0. 493 vs 0. 355 g/L, P〈 0.01 ) and Cd ( 0. 111 vs 0. 065 g/L, P〈 0. 01 ) than Class IVG. The proportion of low complement C4 in IV S group was significantly lower than in IV G group (50. 0% vs 80.9%,P〈0.01).(2) Wire loop(0% vs 42.6%,P〈0.01) and hyaline thrombi(2.4% vs 36.5%,P〈0.01) were significantly rare in IV S than in IV G group. (3)The complete remission (CR) rate within 6 months was significantly lower in the IVS(33.3% vs 53.0% ,P=0. 029) than in IVG group. CR rate within 6 months of IVCY+IVS group( 18.8% vs 52. 7% ,P= 0. 016) was significantly lower than that of IVCY+ IV G group. The 10-year survival without renal function deterioration in IV S group was significantly inferior than that in IV G group (70.4% vs 97.1%,P = 0. 015). Conclusion: Compared to global LN, segmental LN demonstrated a "panic-immune-complex deposit" pathology, a dissatisfied response to traditional immunosuppressant and a poorer prognosis, suggesting different pathogenesis may exsit.
出处 《肾脏病与透析肾移植杂志》 CAS CSCD 北大核心 2014年第2期115-120,145,共7页 Chinese Journal of Nephrology,Dialysis & Transplantation
基金 国家科技支撑计划课题(2011BAI10B04)
关键词 狼疮性肾炎 分型 病理 预后 lupus nephritis classification pathology prognosis
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  • 1Najafi CC, Korbet SM, Lewis EJ, et al. Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis. Kidney Int, 2001,59 ( 6 ) : 2156-2163.
  • 2Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol, 2004,15 (2) : 241-250.
  • 3Hill GS,Delahousse M, Nochy D, et al. Class IV-S versus class IV-G lupus nephritis: clinical and morphologic differences suggesting different pathogenesis. Kidney Int,2005,68 (5) :2288-2297.
  • 4Mittal B, Hurwitz S, Rennke H, et al. New subcategories of class IV lupus nephritis : are there clinical, histologic, and outcome differences? Am J Kidney Dis,2004,44(6) :1050-1059.
  • 5Yokoyama H,Wada T, Hara A, et al. The outcome and a new ISN/ RPS 2003 classification of lupus nephritis in Japanese. Kidney Int, 2004,66(6) :2382-2388.
  • 6Hiramatsu N, Kuroiwa T, Ikeuchi H, et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions. Rheumatology (Oxford) , 2008,47 ( 5 ) : 702-707.
  • 7Kim YG, Kim HW, Cho YM, et al. The difference between lupus nephritis class IV-G and 1V-S in Koreans : focus on the response to cyclophosphamide induction treatment. Rheumatology ( Oxford ), 2008,47(3) :311-314.
  • 8Yu F,Tan Y, Wu LH, et al. Class 1V-G and IV-S lupus nephritis in Chinese patients: a large cohort study from a single center. Lupus, 2009,18(12) : 1073-7081.
  • 9Gao JJ,Cai GY,Liu SW,et al. Characteristics and influence factors of pathologic transformation in the subclasses of class 1V lupus nephritis. Rheumatol Int ,2012,32(6) : 1751-1759.
  • 10Behara VY, Whittier WL, Korbet SM, et al. Patbogenetic features of severe segmental lupus nephritis. Nephrol Dial Transplant, 2010, 25 ( 1 ) : 153-159.

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