狼疮性肾炎临床与病理活动指数相关分析

目的探讨狼疮性肾炎(LN)病理类型与临床的关系,为临床病情的评估及治疗提供参考。方法回顾性分析60例狼疮肾炎患者临床表现与病理类型及相关实验室检测结果,病理分型按WHO 2003年分型标准进行,分别进行活动性指数(AI)、慢性指数(CI)和肾小管间质病变(TIL)评分,同时分析LN病理急性活动指数与临床活动指数的相关性。结果病理类型以Ⅳ型LN最多,占41.67%,其次是Ⅱ型33.33%,V型和Ⅲ型分别占13.33%和11.67%。Ⅱ型与Ⅲ型多表现为肾炎综合征,Ⅳ型和V型多表现为肾病综合征。蛋白尿以Ⅳ型和V型为重,跟Ⅱ型比较有显著差异,Ⅳ型LN的血尿、肾功能不全发生率、抗ds-DNA抗体阳性率最高,其AI亦显著高于其他类型,TIL评分和CI也较Ⅱ型明显高。临床活动指数与病理急性活动性指数呈正相关。结论 LN的病理改变与临床表现有一定的关系,根据其临床表现和实验室检查结果可大致推测其病理类型。

Objective To investigate lupus nephritis （LN） combined with renal biopsy and relevant laboratory parameters, and provide reference for assessing clinical patients’ condition and therapy.Methods 60 patients with LN admitted were collected and their data of renal biopsy and routine laboratory tests were recorded. Pathological classification was based upon the standard criteria of WHO1995, and scored their active index（AI）, chronic index（CI）, tubular interstitial lesion（TIL）. Then we analyzed correlation between clinical acute index and pathological acute activity index. Results Type IV Was most common （41.67%）, type II （33.33%） and V （13.33%） were next. Type II andⅢ usually manifested as nephritis syndrome, while type IV and V mainly as nephritic syndrome. Urine protein in patients with Type IV and V LN is higher than it’s in patients with Type II LN. Type IV was the most active one with a prevalence of hematuria, renal insufficiency and ds-DNA antibody, and AI in Type IV was significantly higher than others’. CI and TIL scoring in type IV was also higher than it’s in Type II. There was a positive correlation between LN clinical acute index and pathological acute activity index.Conclusion There is relation between pathological change and clinical manifestations of lupus nephritis; pathological classification could be foretold according to the clinical manifestations and necessary laboratory parameters.