强直性脊柱炎继发肾脏损害病理及治疗转归研究

Pathology and Therapy of Renal Involvement in Ankylosing Spondylitis

目的:探讨强直性脊柱炎(ankylosing spondylitis,AS)继发肾脏损害的临床病理类型特点及对治疗的转归。方法:回顾性研究2009年3月~2015年3月确诊为AS继发肾脏损害且有肾活检病理的21例患者,分析其临床表现、实验室检查、肾脏组织病理、治疗措施及转归。结果:21例患者中,Ig A肾病8例(38%),系膜增生性肾小球肾炎7例(33.3%),膜性肾病2例(9.5%),轻微病变性肾小球肾炎1例(4.8%),急性间质性肾炎1例(4.8%),亚急性间质性肾炎1例(4.8%),间质性肾炎合并系膜增生性肾炎1例(4.8%)。21例患者在治疗后肾损害均有改善或稳定,其中8例AS继发Ig A肾病患者治疗后的尿红细胞、24 h尿蛋白较治疗前有显著改善(P<0.05);3例间质性肾炎在停用相应的诱发药物后,肾功能有明显改善。结论:肾脏穿刺活检明确病理诊断对AS继发肾脏损害患者意义重大,能指导临床用药,改善预后。

Objective：To define the clinical, biological and histological features and analyzing the responses to treatment of renal involvement in ankylosing spondylitis. Methods：We retrospectively reviewed the medical record of 21 cases with renal involve- ment of ankylosing spondylitis who met the New York criteria from 2009.3 to 2015.3. All these patients were underwent percutancuus needle biopsy of renal under guidance of ultrasound. We identified these patients with renal pathology and analyzed their baseline characteristics, clinical features, laboratory and urinalysis results, treatment protocols and treatment responses. Results：IgA had the： highest incidence of renal involvement（ 8 of 21,38% ）, followed by mesangialproliferative glomerulonephritis （7 of 21, 33.3% ） , membranous nephropathy （2 patients, 9.5% ） and rarely minorlesion glomerulonephritis （1 patient, 4.8% ）, acute interstitial nephritis （1 patient, 4.8% ）, subacute interstitial nephritis （1 patient, 4.8% ） and interstitial nephritis with mesangial- protiierative nephropathy （ 1 patients, 4.8% ）. After treatment, the levels of serum creatinine, red blood cell and proteinuria in urine in the padents were improved or stabilized, but, the differences of these changes do not have statistical significance except lgA nephropadiy pa- tients in this study. Moreover, the renal function of 3 patients with Interstitial nephritis improved significantly after therapy and discon- tinuation of the induced drugs. Conclusion：Renal biopsy is highly recommended to determine prognosis and decide ti^e treatment protocol in clinical practice of renal involvement in ankylosing spondylitis.