增生性狼疮肾炎伴肾脏血栓性微血管病变患者特征及预后分析

Clinical characteristics and prognostic analysis of patients with proliferative lupus nephritis complicated with renal thrombotic microvascular disease

目的 探讨增生性狼疮肾炎伴肾脏血栓性微血管病变患者特征及预后影响因素.方法 96例增生性狼疮肾炎患者按照是否合并血栓性微血管病变症状分为两组,血栓性微血管病变组30例,对照组66例.收集两组临床及实验室数据,比较两组患者临床特征及影响预后的危险因素.结果 血栓性微血管病变组患者肌酐、B型脑钠肽水平、高血压发生率、24 h尿蛋白定量、急性评分、系统性红斑狼疮疾病活动度评分均显著高于对照组(P＜0.01),白蛋白、补体水平、血红蛋白含量、硬化肾小球含量显著低于对照组(P＜0.01).血栓性微血管病变组的糖皮质激素用量显著高于对照组(P＜0.01),两组穿刺后诱导方案比较差异有统计学意义(P＜0.05),血栓性微血管病变进入终末期肾病率显著高于对照组(P＜0.01),完全缓解率显著低于对照组(P＜0.05).终末期肾病组血栓性微血管病变症状发生率显著高于非终末期肾病组(P＜0.01),两组肾脏病理比较差异有统计学意义(P＜0.01),自身抗体比较差异无统计学意义(P＞0.05).结论 增生性狼疮肾炎患者容易出现血栓性微血管病变症状,肌酐水平更高,且更容易转入终末期肾病.肌酐和系统性红斑狼疮疾病活动度评分可能是提醒增生性狼疮肾炎伴肾脏血栓性微血管病变的预测因子,肾脏血栓性微血管病变表现可能为此类患者的危险预后因素之一.

Objective To investigate the clinical features and prognostic factors of patients with proliferative lupus nephritis (LN) complicated with renal thrombotic microvascular disease. Methods 96 cases with proliferative LN were divided into two groups according to whether the merger of TMA symptoms, 30 cases in the TMA group.66 cases in the control group. Collect the clinical and laboratory data of the two groups, and compare the clinical features and prognostic risk factors of the two groups. Results In the TMA group, creatinine, B type natriuretic peptide(BNP), incidence of hypertension, 24-hour urine protein, acute score, SLE activity score were all significantly higher than those in the control group (P ＜0.01),albumin, complement level, HGB, sclerotic glomeruli content were all significantly lower than those in the control group (P＜0.01). Glucocorticoid dosage in the TMA group was significantly higher than that in the control group (P＜0.01), there is statistic significance in the induction programme after puncture between the two groups (P＜0.05),the rate of nephropathy in the terminal stage of TMA was significantly higher than that of the control group (P＜0.01), CR rate was significantly lower than that of the control group (P＜0.05). The rate of TMA in the terminal stage TMA group was significantly higher than that of the non terminal stage TMA group (P＜0.01),there is statistic significance in the renal pathology between the two groups (P＜0.01),there is no statistic significance in the autoantibody between the two groups (P＞0.05). Conclusion Patients with proliferative LN are more likely to get TMA symptom, with creatinine level, and are more likely to develop ESRD. Creatinine and SLE activity score may be predictive factors of proliferative lupus nephritis complicated with renal thrombotic microvascular disease, TMA may be one of the risk prognostic factors of this kinds of patients.