狼疮性肾炎病理分型与临床指标之间的关系

Relationship between renal pathological classifications and clinical parameters

目的探讨狼疮性肾炎(LN)不同病理类型、肾脏病理活动性指数(AI)、慢性指数(CI)和临床及实验室指标间的相关性。方法收集2011年2月—2014年3月在安徽医科大学第一附属医院住院并进行肾活检的96例LN患者病例资料,对LN患者的AI、CI及系统性红斑狼疮(SLE)疾病活动性积分(SLEDAI)进行评分,回顾性分析其病理特点与临床及实验室指标间的相关性。结果①依据2003年ISN/RDS分型方案,96例LN患者中Ⅰ型0例(0.00%),Ⅱ型9例(9.38%),Ⅲ型9例(9.38%),Ⅳ型67例(69.79%),Ⅴ型11例(11.46%)。②不同病理类型的LN患者间AI、CI、SLEDAI是明显不同的,LSD检验结果显示Ⅳ型LN患者的AI评分均高于Ⅱ型、Ⅲ型、Ⅴ型(P<0.001)。Ⅳ型LN患者的CI评分均高于Ⅱ型(P<0.05),Ⅳ型LN患者的SLEDAI评分高于Ⅱ型、Ⅲ型(P<0.05)。③随着LN患者SLEDAI的增高,肾脏病理AI分数逐渐增高,差异具有统计学意义(F=15.469,P<0.001)。不同SLEDAI组患者LN间的CI是没有差别的(F=0.442,P=0.724)。④Ⅳ型LN患者尿蛋白明显高于Ⅱ型、Ⅴ型LN患者(F=1.348,P=0.002;F=0.894,P=0.022);Ⅳ型LN患者的血尿酸高于Ⅱ型、Ⅴ型LN患者(F=98.396,P=0.011;F=72.063,P=0.040)。⑤相关性分析结果显示:LN病理上的AI和SLEDAI积分、尿蛋白、Upr24、ANA、ACL、抗C1q呈正直线相关(P<0.05),和补体C3、C4、HB呈负直线相关(P<0.05);而CI和尿蛋白呈正直线相关(P<0.05),和24 h尿尿酸呈负直线相关(P<0.05)。结论 LN患者病理分型及AI、CI积分与临床指标密切相关,SLEDAI积分和补体C3可间接反映LN病理AI水平。

Objective To investigate the relationship between renal pathological classifications,activity index（ AI）,chronicity index（ CI） in Lupus nephritis and clinical parameters,as well laboratory index. Methods Ninety-six LN patients with kidney biopsy were collected from February,2011 to March,2014. The retrospective analyses were conducted for the correlations between pathological manifestations and clinical,laboratory index. Results ① According to ISN / RDS in2003,out of 96 LN patients,none of case was categorized as LN-Ⅰ,9 cases（ 9. 38%） were belonged to LN-Ⅱ,9 cases（ 9. 38%） were classified as LN-Ⅲ,67 cases（ 69. 79%） were LN-Ⅳ,11 cases（ 11. 46%） were LN-Ⅴ. ②SLEDAI,AI,CI in LN patients were obviously different among different pathological types,LSD test results showed that AI in LN-Ⅳ were higher than that in LN-Ⅱ,LN-Ⅲ and LN-Ⅴ（ P〈 0. 0 001）. CI in LN-Ⅳ were higher than that in LN-Ⅱ（ P〈 0. 05）.SLEDAI in LN-Ⅳ were elevated than LN-Ⅱ and LN-Ⅲ（ P〈 0. 05）. ③Along with the increasing of SLEDAI in LN patients,AI gradually raised（ F = 15. 469,P 〈0. 001）. There were no statistic difference regarding CI among patients with different SLEDAI（ F = 0. 442,P = 0. 724）. ④Urine protein level in LN-Ⅳ was remarkable higher than that in LN-Ⅱ and LN-Ⅴ（ F = 1. 348,P = 0. 002; F = 0. 894,P = 0. 022）. Serum uric acid level in LN-Ⅳ was higher than that in LN-Ⅱ and LN-Ⅴ（ F = 98. 396,P = 0. 011; F = 72. 063,P = 0. 040）. ⑤Results showed that AI was positively correlated with SLEDAI,urine protein,24 hour urinary protein,ACL,ANA and anti-C1 q antibody levels（ P〈 0. 05- 0. 001）,while negatively associated with serum C3,C4 and HB levels（ P〈 0. 05）. There was a positive correlations between CI and urine protein,a negative correlations between CI and amount of urine uric acid in 24 hours（ P〈 0. 05）. Conclusion The pathological type in patients with LN and AI,CI are closely related with clinical and laboratory indexes. We should emphasis the value of SLEDAI and serum C3 on indicating AI in pathological manifestation.