老年狼疮性肾炎患者临床与肾脏病理分析

Analysis of clinical and histological features of late onset lupus nephritis

目的分析老年狼疮性肾炎患者的临床与肾脏病理特点。方法回顾性分析2011年1月至2016年6月在我院确诊的狼疮性肾炎患者，根据发病年龄，将患者分为2组，其中25例发病年龄≥60岁为老年组，同时随机选择50例发病年龄〈60岁为成年组，比较两组患者的临床表现、实验室指标、肾脏病理及药物疗效。结果老年组和成年组的发病年龄分别是（62．2±3．1）岁和（33．2±10．0）岁（t=18．452，P=0．000），女性与男性比例分别为1．3：1．0和5．3：1．0（χ2=6．908，P=0．009）。老年组高血压15例（60％）（χ2=9．375，P=0．002）、血肌酐（229．1±4．4）μmol／l（t=80．644，P=0．000）明显高于成年组。老年组抗ds-DNA抗体阳性明显低于成年组（χ2=6．304，P=0．012）。与成年组相比，老年组肾脏病理的球性硬化20例（80％）（χ2=14．109，P=0．000）、纤维性新月体9例（36％）（χ2=9．040，P—0．0033、肾小管萎缩23例（92％）（χ2=7．440，P—0．006）、间质纤维化23例（92％）（χ2=7．440，P=0．006）、慢性指数3．4±1．9（t=3．648，P=0．000）明显更高。结论老年与成年狼疮性肾炎的临床和组织学特征有=些差异。老年性狼疮性。肾炎女性比例降低，高血压发生率更高，血清抗ds—DNA阳性率降低，肾功能量损及慢性病变更严重。

Objective To compare the clinical and histologicai characteristics between eiderly lupus nephritis （LN） patients and adult LN patients. Methods Patients diagnosed with LN from January 2011 to October 2016 at Fuzong Medical Hospital were enrolled in this retrospective study. Recruited patients were assigned into two groups according to age： the elderly-onset group （aged over 60, n= 25） and the adult-onset group （aged below 60, n= 50）. Clinical features, laboratory manifestations,histological data and treatment responses were analyzed and compared. Results The average ages at the onset of systemic lupus erythematosus （SLE） in the elderly-onset group and the adult-onset group were （62.2 ±3.1 ）years and （33.2±10.0） years （t=18. 4, P=0.000）, respectively. The female to male ratio was lower in the elderly group compared with that in the adult group （1.3 ： 1.0 vs 5.3 ： 1.0, χ2 = 6. 908, P= 0. 009）. The prevalence of hypertension in the elderly-onset group was much higher than that in the adult-onset group （χ2 =9. 375, P= 0. 002）. Also, elderly patients showed significantly higher serum creatinine levels （t= 80. 644, P=0. 000） and lower rates of positive anti-dsDNA （χ2 =6. 304, P=0. 012）. Additionally, elderly- onset individuals were correlated with higher scores of glomerular sclerosis （80%, χ2 =14. 109, P=0. 000）, fibrous crescents （36%, χ2 = 9. 040, P= 0. 003）, tubular atrophy （92%, χ2 = 7. 440, P= 0. 006）, interstitial fibrosis （92%, χ2 =7. 440, P=0. 006） and chronicity index （3.4±1.9, t=3. 648, P=0. 000）, compared with the adult-onset group. Conclusions There are clinical and histological differences between elderly and adult LN patients. LN in the elderly is characterized by a low female to male ratio, a low prevalence of positive anti-dsDNA, high blood pressure, severe kidney injury, and chronic lesions in renal pathology.