系统性红斑狼疮患者临床表现与肾脏病理和实验室指标的临床分析

Analysis of Clinical Manifestations,Renal Pathology and Laboratory Indicators in Patients with Systemic Lupus Erythematosus

目的分析具有狼疮肾炎(LN)的系统性红斑狼疮(SLE)患者肾损害表现与病理及相关实验室检测结果,探讨LN的肾损害表现与病理分型、实验室检查及自身抗体的关系。方法纳入2012年至2015年在新疆维吾尔自治区人民医院风湿免疫科明确诊断并有肾穿活检结果的SLE患者121例,根据2012年ACR狼疮肾炎(LN)的管理指南将患者分为有LN表现组和无LN表现组,根据MRDR公式计算的eGFR值将患者分为肾功能减低组和肾功能正常组,收集患者临床资料和实验室指标资料。结果121例SLE患者肾脏病理以LN-Ⅱ型所占比例最高(50.4%)临床表现中最常见的为关节炎(占73.6%),其次为脱发、皮疹、口腔溃疡和浆膜炎。有LN表现者中,LN-Ⅳ型患者占比为24.3%高于无LN表现者(4.3%),差异具有统计学意义(P=0.005)。有LN表现者SLEDAI评分为(9.12±3.96),高于无LN表现者,差异有统计学意义(P=0.002);血清补体C1q水平为(135.84±42.37)mg/L,低于无LN表现者,差异有统计学意义(P=0.023);血清CysC水平为(1.4±0.82)μg/mL,高于无LN表现者,差异有统计学意义(P=0.027)。有LN表现者抗dsDNA抗体阳性率为60.8%,高于无LN表现者,差异有统计学意义(P=0.04);血清ANuA水平为48.7(14.4,115.4)RU/m,高于无LN表现者,差异有统计学意义(P=0.015);抗C1q抗体水平为47.3(10.6,97.4)RU/m,高于无LN表现者,差异有统计学意义(P=0.042),两组比较差异有统计学意义(P<0.05)。有LN表现者中,肾脏病理中有C1q沉积的患者所占比例高于无LN表现者,两组比较差异具有统计学意义,差异有统计学意义(P=0.002)。在肾功能减低患者中,LN-Ⅳ型所占比例较多为42.9%,高于肾功能正常者(8.6%),两组比较差异具有统计学意义(P<0.001)。肾功能减低组SLEDAI评分为(9.54±3.64)分,高于肾功能正常组,差异有统计学意义(P=0.017);血清补体C1q水平为(120.16±37.63)mg/L,低于肾功能正常,差异有统计学意义(P=0.022);血清Cys C水平为(1.56±0.75)μg/mL,高于肾功能正常组,差异有统计学意义(P<0.001);血清抗C1q抗体水平为62(17.85,136.8)AU/mL,高于肾功能正常组,差异有统计学意义(P=0.001)。结论LN的临床表现、肾损害指标与肾脏病理和实验室指标有一定的相关性,血清CysC、抗C1q抗体、补体C1q可以作为判断LN预后和选择治疗方案的参考指标。

Objective To analyze the chilinical manifestations,renal pathology and laboratory tests in systemic lupus erythematosus(SLE)patients with lupus nephritis(LN),and the relationship between these aspects.Methods A total of 121 SLE patients clearly diagnosed in the Department of Rheumatology of Xinjiang Uygur People's Hospital from 2012 to 2015 were included,their Kidney al biopsy results were available.LN manifestations was defined according to the ACR^(2)012 guidelines of LN.And the patients were also divided into renal dysfunction group or normal renal function group according to eGFR.Clinical and laboratory data were collected.Results Type II LN took a proportion of 50.4%,which was the highest among other types.The most common clinical manifestations were arthritis(73.6%),followed by hair loss,skin rash,oral ulcers and serous inflammation.In patients with LN manifestations,24.3%of patients was type IV LN,compared with 4.3%in whom without LN manifestations,the difference was statistically significant(P=0.005).SLEDAI score of patients with LN manifestations was(9.12±3.96),statistically higher than that of patients without LN manifestations(P=0.002).Serum complement C1q level was(135.84±42.37)mg/L,statistically lower than that of patients without LN manifestations(P=0.023).The serum CysC level was(1.4±0.82)μg/ml,which was statistically higher than that of patients without LN manifestations(P=0.027).The dsDNA antibody positive rate in patients who had LN manifestations was 60.8%,higher than that without LN manifestations(P=0.04).The serum ANuA level was 48.7(14.4,115.4)RU/m,which was higher than that of patients without LN manifestations(P=0.015).The level of anti-C1q antibody was 47.3(10.6,97.4)RU/m,higher than that of the patients without LN manifestations(P=0.042),and the difference between the two groups was statistically significant.In the patients with LN manifestations,patients with C1q deposition in renal pathology had a higher proportion than those without LN manifestations,and the difference between the two groups was statistically significant(P=0.002).In patients with renal dysfunction,the proportion of type IV LN was 42.9%,higher than that of patients without normal renal function(8.6%),and the difference between the two groups was statistically significant(P<0.001).The SLEDAI score of the renal dysfunction group was(9.54±3.64),statistically higher than that of the normal renal function group(P=0.017).The serum complement C1q level was(120.16±37.63)mg/L,statistically lower than normal renal function group(P=0.022).Serum CysC level was(1.56±0.75)μg/mL,statistically higher than that of the group with normal renal function(P<0.001).The serum anti-C1q antibody level was 62(17.85,136.8)AU/mL,higher than that of the group with normal renal function,the difference between the two groups was statistically significant(P=0.001).Conclusions The clinical manifestations and renal damage indicators of LN had some relationship with renal pathology and laboratory tests,and serum CysC,anti-C1q antibody,and complement C1q could be used as the reference indexes to judge prognosis of LN and select therapeutic decision.