重复肾活检狼疮性肾炎患者临床病理分析

Clinical and pathological analysis of repeated renal biopsy in patients with lupus nephritis

目的通过对重复肾活检狼疮性肾炎患者前后两次肾活检的临床及病理资料进行回顾性分析,探讨狼疮性肾炎患者进行重复肾活检的合理性及临床指征。方法选取于2012年11月—2016年12月就诊于郑州大学第一附属医院并进行重复肾活检的患者41例,进行回顾性分析,统计两次肾活检前患者的相关信息,主要包括一般信息,病理资料,临床表现以及实验室检查等,运用SPSS 23.0软件进行统计学分析。结果男性2例,女性39例,初次肾活检平均年龄(28.88±9.95)岁,重复肾活检平均年龄(33.27±10.36)岁,两次肾活检平均间隔时间(4.36±2.51)年。前后两次肾活检患者病理类型的分布差异具有统计学意义,初次肾活检患者病理类型分布为Ⅳ型15例(36.6%)、Ⅲ型7例(17.1%)、Ⅲ+Ⅴ型5例(12.2%)、Ⅳ+Ⅴ型5例(12.2%),Ⅱ型5例(12.2%),Ⅴ型4例(9.7%),而重复肾活检患者病理类型分布为Ⅳ+Ⅴ型16例(39.0%),Ⅳ型10例(24.4%),Ⅲ+Ⅴ型9例(22.0%),Ⅲ型3例(7.3%),Ⅱ型2例(4.9%),Ⅴ型1例(2.4%)。前后两次肾活检前临床类型分布有统计学差异,初次肾活检患者主要临床类型以肾炎综合征型(51.2%)为主,重复肾活检患者临床类型则以肾功能不全型(46.3%)为主。在前后两次肾活检前的临床表现中,颜面部红斑,水肿,高血压,贫血,肾功能不全,血尿,大量蛋白尿,低蛋白血症,低补体血症这几项临床表现具有统计学差异,相较于初次肾活检,重复肾活检时以上临床表现出现患者数量均明显增加。对前后两次实验室检查结果进行统计学分析,其中血红蛋白,血浆白蛋白,24 h尿总蛋白,血肌酐四项指标差异均具有统计学意义,其中血红蛋白及血浆白蛋白重复肾活检前较初次肾活检明显降低,而24 h尿总蛋白及血肌酐值则明显升高。结论重复肾活检对于狼疮性肾炎患者的准确再诊断是极其必要的,患者进行重复肾活检往往因病情未明显缓解或者复发,并伴随着各项临床及病理表现的加重。

Objective To retrospectively analyze the clinical and pathological data of two renal biopsies in patients with lupus nephritis after repeated renal biopsy,and to explore the rationality and clinical indications of repeated renal biopsy in patients with lupus nephritis. Methods Totally 41 patients were selected from November 2012 to December 2016 in the First Affiliated Hospital of Zhengzhou University and repeated renal biopsy,were retrospectively analyzed. The patients information statistics including general information,pathological data,clinical manifestations and laboratory examination,SPSS 23. 0 software was used for statistical analysis. Results 1. Two men,thirty-nine women,the average age of primary renal biopsy was 28. 88 ± 9. 95 years old,the average age of repeat renal biopsy was 33. 27 ± 10. 36 years old,and the average interval time of two renal biopsy was 4. 36 ± 2. 51 years. 2. Renal biopsy pathology distribution＇s difference was statistically significant in the two group. Pathology of renal biopsy in patients with the first renal biopsy of distribution of type Ⅳ is 15 cases（ 36. 6%）,7 cases of type Ⅲ（ 17. 1%）,5 cases of type Ⅲ ＋ Ⅴ（ 12. 2%）,5 cases of type Ⅳ ＋Ⅴ（ 12. 2%）,5 cases of Ⅱ type（ 12. 2%）,4 cases of Ⅴ type（ 9. 7%）,Repeated renal biopsy in patients with the type of distribution of type Ⅳ ＋ Ⅴ in 16 cases（ 39%）,10 cases of type Ⅳ（ 24. 4%）,9 cases of type Ⅲ ＋ Ⅴ（ 22%）,3 cases of type Ⅲ（ 7. 3%）,2 cases of type Ⅱ（ 4. 9%）,1 cases of type V（ 2. 4%）. 3. There were statistically significant differences in clinical types of two group. The most common type of glomerulonephritis was glomerulonephritis syndrome（ 51. 2%） in the first. The clinical type of repeat renal biopsy patients was mainly renal insufficiency（ 46. 3%）. 4. Clinical manifestations of two times renal biopsy in facial erythema,edema,hypertension,anemia,renal insufficiency,hematuria,proteinuria,hypoalbuminemia,hypocomplementaemia these clinical manifestations were statistically significant. 5. Compared with first renal biopsy,the hemoglobin and serum albumin was lower,and 24 h urinary protein and serum creatinine values were significantly increased. Differences are statistically significant. Conclusion Repeated renal biopsy is very necessary for accurate diagnosis of lupus nephritis,patients do it,because the disease is not relieved or recrudescence,It is accompanied by the aggravation of clinical and pathological manifestations.