狼疮性肾炎患者的临床表现与病理类型的相关性分析

目的 :　探讨狼疮性肾炎患者的临床表现、实验室检查与病理类型之间的关系 ,为临床治疗提供依据。方法 :　本文对 5 4例患者在B超定位下 ,用Meghini肾穿刺针抽吸法获取肾组织 ,标本分别作HE染色、直接免疫荧光 (作抗人IgG、IgM、IgA、C3和HBsAg染色 )和电镜检查 ,以及患者的临床表现、实验室检查等分析。统计学分析采用STATA (4.0 )软件进行Fisher检验。结果 :　 5 4例患者的病理类型分轻微病变型 (2例 )、膜型 (7例 )、膜增生型 (11例 )、系膜增生型 (8例 )、弥漫增生型 (16例 )、局灶节段增生型 (8例 )和硬化型 (2例 )共 7型 ,其血尿、蛋白尿、尿蛋白定量、血清低白蛋白 ,肾小管上皮细胞变性坏死、萎缩、基膜增生 ,肾间质炎症细胞浸润、纤维化、血管内膜增厚 ,直接免疫荧光检测中抗人IgM、IgA和C3阳性 ,临床轻度损害型等指标在 7型之间比较差异均有显著性 (P <0 .0 5 ) ,以及各型之间数据分布不一致 ,均以膜增生型和弥漫增生型中较为明显。 7例进行电镜检查 ,发现上皮下均有电子致密物沉积。结论 :　肾穿刺活检对于狼疮性肾炎患者的临床治疗和预后判断具有指导意义

Correlation between clinical and pathological characteristics in patients with lupus nephritis

Objective: To analyze the correlation between the clinical characteristics, laboratory tests and pathology in patients with lupus nephritis (LN). Methods: Renal tissues were taken by Meghini needle biopsy under the location of B-ultrasound in 54 patients with LN. The specimens were stained with hematoxylin-eosin, direct immunofluorescence (DIF) (anti-human IgG, IgM, IgA, C 3 and HBsAg) and examined under electron microscope. The data of clinical characteristics and laboratory tests were analyzed. Fisher statistic analysis was used by STATA (4.0) software.Results: The 54 cases of LN were divided into seven groups according to pathological characteristics using WHO classification: normal (2 cases), membranous type (8 cases), membranous proliferative type (11 cases), mesanginal proliferative type (8 cases), diffuse proliferative (16 cases), focal proliferative (8 cases) and sclerosal type (2 cases). There was comparatively significant difference among these seven subtypes between the pathological findings and following characteristics: hematuria, albuminuria, quantitative determination of 24 hours albuminuria, hypoalbuminemia, cellular degeneration, necrosis and atrophy, thickening of tubular basement membrane (TBM), renal tubular epithelium, inflammatory cellular infiltration, fibrosis and blood vessel endothelial hyperplasia, renal infiltration, the positivity of IgM, IgA, and complement C 3 manifesting as granular deposits detected by DIF and mild clinical injury type, etc. The electronic dense deposits were found under epithelium in all seven cases by electronmicroscopy. Conclusion : The biopsy through renal puncture offers an important clue in the guidance of treatment and prediction of prognosis of lupus nephritis.