临床特点联合实验室指标对狼疮肾炎病理分型的预测研究

Clinical and laboratory predictors of pathological classification of lupus nephritis

目的通过临床及实验室指标,建立狼疮肾病理分型的预测模式。方法 2011-2015年我院住院有肾病理的系统性红斑狼疮(systemic lupus erythematosus,SLE)患者,经糖皮质激素等治疗2月以上,尿蛋白仍阳性的患者201例,分析其临床及实验室指标,采用Epi Data 3.1和SPSS 21.0软件进行统计。结果Ⅱ型17例,Ⅲ型26例,Ⅳ型135例,Ⅴ型23例;单因素分析:增殖型年龄及发病年龄均小、SLEDAI高、贫血多、C3低、C1q(64.0%)及ds-DNA阳性率均高(53.4%);膜型发病年龄大,ds-DNA阳性率低(13.0%);系膜型卧位后尿蛋白转阴性率为67.4%。Logistic回归分析显示,相对于其它类型,系膜型SLEDAI低,卧位后尿蛋白转阴性率高;增殖型SLEDAI高、尿蛋白阳性率及抗ds-DNA阳性率均高;膜型发病年龄大、抗ds-DNA阳性率低。结论狼疮肾病理分型的预测模式:SLEDAI低,卧位后尿蛋白转阴性率高是Ⅱ型的强预测指标;SLEDAI高、尿蛋白阳性、抗ds-DNA阳性,是Ⅲ/Ⅳ型的预测指标;发病年龄大、抗ds-DNA阳性率低是Ⅴ型的预测指标。

Objective To establish a relative predictive model of pathology of lupus nephritis based on clinical and laboratory results. Methods Lupus nephritis patients who had renal biopsies were consecutiVely recruited in our hospital from 2011 to 2015. 201 patients had already received an over two months treatment with glueoeorticoid, but they still had positive proteinuria. The clinical manifestations and laboratory indexes of these patients were analyzed. Epi Data 3.1 and SPSS 21.0 were used for statistical analysis. Results Seventeen cases with class Ⅱ lupus nephritis, 26 cases with classⅢ lupus nephritis, 135 cases with class iv lupus nephritis and 23 cases with class V lupus nephritis. In single analysis, patients with proliferative lupus nephritis were younger and had earlier first-onset age, higher SLEDAI, more anemia, lower serum levels of C3 complement components, higher positive rate of anti-C1 q antibody （64. 0% ） and anti-dsDNA antibody （ 53.4% ）. Patients with membranous lupus nephritis had older first onset age and lower positive rate of anti-dsDNA anti- body （ 13.0% ）. Proteinuria turned negative rate was 67.4% in the supine position in patients with mesangioproliferative lupus nephritis. In logistic regression anlysis, patients with mesangioproliferative lupus nephritis had lower SLEDAI and higher incidence of disappearance of the protein loss in the supine position. Patients with proliferative lupus nephritis had higher SLEDAI, positive rate of proteinuria and anti-dsDNA antibody. Patients with membranous lupus nephritis had later first-onset age and lower positive rate of anti-dsDNA antibody. Conclusions The predictive model of pathological classifi- cations of lupus nephritis has been established. Lower SLEDAI and higher incidence of negative proteinuria test in the su- pine position could be the strong predictors for class Ⅱ lupus nephritis. Higher SLEDAI, positive rate of proteinuria and anti-dsDNA antibody may predict class Ⅲ or iv lupus nephritis. Later first-onset age and lower positive rate of anti-dsDNA antibody may predict class V lupus nephritis.