55例狼疮性肾炎合并血栓性微血管病变临床危险因素分析

Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis

目的分析狼疮性肾炎(lupus nephritis,LN)伴血栓性微血管病变(thrombotic microangiopathy,TMA)的临床表现、实验室特点、病理特点、临床治疗结果,探讨其临床危险因素。方法选取2008年8月至2016年7月在本科接受肾活检、病理诊断为LN伴TMA患者55例,分为存活组(34例)与死亡组(21例);利用Logistic回归分析发生死亡的临床危险因素。结果从临床表现、实验室检查、病理特点、临床治疗结果等因素进行分析,与存活组比较,死亡组急诊血液透析、感染发生率较高(P<0.01),补体C3较低(P=0.04),CRP(P=0.047)、24 h尿蛋白定量(P=0.02)、血肌酐(serum creatinine)水平较高(P=0.04),SLEDAI-2000评分较高(P=0.02);当血小板计数(PLT)<50×10~9/L时,死亡风险明显增加。Logistic回归分析结果显示,急诊透析、感染、PLT<50×10~9/L时为患者死亡的独立危险因素。结论急诊透析、感染、血小板降低是伴TMA狼疮性肾炎患者临床危险因素。

Objective To investigate the clinical manifestations, features of laboratory results, pathological characteristics, clinical risk factors and outcomes of lupus nephritis （LN） patients with thrombotic microangiopathy （TMA）. Methods Totally 55 LN patients with TMA diagnosed pathologically in our department from August 2008 to July 2016 were enrolled in this study. They were divided into survival group （n = 34） and dead group （n = 21 ）. Logistic regression analysis was used to analyze the clinical risk factors of death. Results Based on the clinical manifestations, laboratory tests, pathological features, and clinical outcomes, our analyses indicated that the dead group had higher incidences of acute hemodialysis and infection （P 〈 0.01 ）, lower complement C3 level （ P = 0.04）, but high levels of C-reactive protein （ P = 0. 047 ）, 24-hour urine protein （P = 0.02） and serum ereatinine （ P = 0.04 ）, and higher SLEDAI 2000 score （ P = 0.02） when compared with the survival group. The risk of death was increased significantly when platelet count 〈 50×10^9/L. Logistic regression analysis showed emergency dialysis, infection and lower platelet count （ 〈50×10^9/L） were independent risk factors for death. Conclusion Emergency dialysis, infection, and decreased platelet count are risk factors for TMA in LN patients.