70例狼疮性肾炎患者肾脏纤维化及临床指标分析

Renal fibrosis and clinical parameters in 70 patients with lupus nephritis

目的总结狼疮性肾炎患者的临床表现,肾脏纤维化、血清学及免疫学指标变化。方法回顾性分析经肾穿刺活检组织病理证实70例狼疮性肾炎患者的临床资料。结果70例首发症状主要为皮疹、溃疡、水肿;病理类型中Ⅱ型13例,Ⅲ型16例,Ⅳ型24例,Ⅴ型12例,Ⅵ型1例,Ⅲ+Ⅴ型1例,Ⅳ+Ⅴ型3例;24例处于活动期,其中Ⅳ型12例;免疫荧光示免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM、C3阳性沉积者分别有59、59、58、64例,IgA、IgG、IgM、C3均阳性沉积者54例,沉积部位位于系膜区、基底膜、上皮下等多处,肾小管上皮区有Nox4表达,肾小球系膜区、肾小管上皮及间质内见大量平滑肌肌动蛋白、纤维连接蛋白表达;70例抗核抗体均为阳性,活动期者抗干燥综合征抗原A抗体阳性率最高;活动期者血红蛋白、白蛋白、IgA、补体C3水平明显低于非活动期者,血尿素氮、血肌酐、24 h尿蛋白定量、C反应蛋白较非活动期者高,红细胞沉降率较非活动期者快(P<0.05)。结论狼疮性肾炎患者首发症状以皮疹、溃疡、水肿等肾外症状多见,病理类型以Ⅳ型为主,肾脏纤维化标志物在肾小球系膜区、肾小管上皮及间质内大量表达;活动期者Ⅳ型最多,氧化应激及炎症水平增高,营养状况较差。

Objective To summarize the clinical manifestations of lupus nephritis,and the changes of renal fibrosis as well as serologic and immunologic indexes.Methods The clinical data of 70 patients with lupus nephritis confirmed by renal biopsy were retrospectively analyzed.Results The initial symptoms of 70 patients were rash,ulcer and edema.The pathologic types included typeⅡin 13 patients,typeⅢin 16,typeⅣin 24,typeⅤin 12,typeⅥin 1,typeⅢ+Ⅴin 1,and typeⅣ+Ⅴin 3.In 24 patients in active stage,12 patients were in typeⅣ.Immunoglobulin(Ig)A,IgG,IgM and C3 was positively expressed in 59,59,58 and 64 patients,respectively,and all above indexes were positively expressed in 54 patients,in the mesangial region,basal membrane and subepithelial region.Nox4 was expressed in the epithelial area of renal tubule,a large amount ofα-smooth muscle actin and fibronectin were expressed in the glomerular mesangial region,renal tubular epithelium and interstitial region.The antinuclear antibody of 70 patients was positive,and the positive rate of anti-Sj?gren syndrome A antibody was the highest in active stage.The levels of hemoglobin,albumin,IgA and C3 in active stage were significantly lower than those in non-active stage,while the levels of blood urea nitrogen,serum creatinine,24-h urinary protein quantification,C-reactive protein and erythrocyte sedimentation rate were significantly higher in active stage than those in non-active stage(P<0.05).Conclusion Lupus nephritis initially presents extrarenal symptoms as rash,ulcer and edema,commonly in pathologic typeⅣ.Renal fibrosis markers are massively expressed in the glomerular mesangial region,renal tubular epithelium and interstitial region.Lupus nephritis patients in active stage are mostly in pathologic typeⅣ.The level of oxidative stress and inflammation increase,while the state of nutrition is poor.