58例狼疮性肾炎病理与临床分析

Clinical and pathological analysis of 58 case with lupus nephritis

目的 分析肾活检及相关实验室检测结果 ,探讨狼疮性肾炎 (LN)病理类型与临床表现的关系。方法 对 5 8例LN患者进行肾活检及常规实验室检查。根据WHO 1982年标准进行病理分型 ,并分别进行活动性指数 (AI)、慢性指数 (CI)和肾小管间质病变 (TIL)评分。结果 病理类型以Ⅳ型LN最多 ,占 3 8%,其次是Ⅱ型 ( 2 6%)和Ⅴ型 ( 2 4%)。Ⅱ型与Ⅲ型多表现为肾炎综合征 ,Ⅳ型和Ⅴ型多表现为肾病综合征。Ⅳ型LN的血尿、高血压、肾功能不全发生率最高 ,其AI亦显著高于其他类型。LN肾间质受累以Ⅳ型最为显著。血Cr水平与肾间质受累程度呈正相关。与TIL 0～ 1级相比 ,2～ 3级病程相对要长。 1～ 2级者尿蛋白排泄较 0级与 3级为高。结论 LN的病理类型与临床表现有一定关系 ,根据其临床表现和实验室检查结果可大致推测其病理类型。肾活检对判断疾病活动性 。

Objective To investigate the relationship between pathological classification and clinical manifestations of lupus nephritis(LN) combined with renal biopsy and relevant laboratory parameters.Methods 58 patients with LN admitted during 1994～2001 in Tongji Hospital were collected and their data of renal biopsy and routine laboratory tests were recorded. Pathological classification was based upon the standard criteria of WHO 1982, and scored their active index(AI)?chronic index (CI)?tubular interstitial lesion (TIL).Results Type Ⅳ was most common (38%), typeⅡ(26%) and Ⅴ(24%) were next. TypeⅡand Ⅲ usually manifested as nephritis syndrome, while type Ⅳ and Ⅴ mainly as nephrotic syndrome. Type Ⅳ was the most active one with a prevalence of hematuria, hypertension and renal insufficiency, and a highest AI. TIL scoring was highest in typeⅣ too. There was a positive correlation between serum creatinine level and TIL scoring. Compared with TIL 0～1, the clinical course of TIL 2～3 was a bit longer. Proteinuria in TIL 1～2 was more prominent than in TIL 0 and 3.Conclusions A positive correlation is demonstrated between pathological classifications and clinical manifestations of lupus nephritis; pathological classification could be foretold according to the clinical manifestations and necessary laboratory parameters. Renal biopsy is important in diagnosis of active status, in designing of therapeutic regimen and predicting of prognosis in lupus nephritis.