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狼疮肾炎临床与病理相关性分析 总被引:2,自引:0,他引:2
目的:探讨狼疮肾炎(LN)的临床表现与病理类型之间的关系。方法:对近5年来收治的159例系统性红斑狼疮(SLE)的病例临床特征进行回顾性分析,并重点对已经在B超或彩超引导下行经皮肾穿刺活检术,光镜、免疫组化及电镜检查,取得病理检查结果的48例LN进行统计分析。结果:48例中,男5例,女43例,男女比例为1:9;临床类型:亚临床型2例,肾炎综合征22例及肾病综合征24例;病理类型:Ⅱ型9例,Ⅲ型5例,Ⅳ型19例,V型13例,Ⅵ型2例;肾小管间质轻度损害35例,中度损害10例,重度损害3例。LN的病理类型与临床表现有一定的相关性,临床活动性(SLEDAI)与病理类型无相关性。结论:肾活检有助于对系统性红斑狼疮肾损害进行明确诊断,有助于了解其病理活动性、慢性指数及肾小管间质损害程度,有助于选择最佳的治疗方案和判断预后。从临床表现和实验室检查可初步推测病理类型,但临床活动性与病理活动性存在不一致性;病理活动性及慢性评分能更准确了解肾损害情况。 相似文献
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我们报道一组以大量胸腹水、严重低蛋白血症伴少量蛋白尿为临床特征的狼疮肾炎(LN)患者,分析此类患者的临床病理特点、诊断思路及治疗转归,以加深临床医师对LN并发由系统性红斑狼疮(SLE)导致的失蛋白性肠病(PLE)诊治的认识。 相似文献
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探讨弥漫增殖性狼疮肾炎Ⅳ型两亚型Ⅳ-S与Ⅳ-G的临床病理特点及对药物治疗的反应。 方法 78例经肾穿刺证实的Ⅳ型狼疮肾炎,按2003年国际肾脏病学会联合肾脏病理学会(ISN/RPS)狼疮肾炎分型标准,分为Ⅳ-S亚型22例、Ⅳ-G亚型56例两组。比较两组的临床表现、肾脏病理及对药物治疗反应。 结果 两组在发病年龄、性别、病程、平均动脉压、血红蛋白、补体C4和Scr等方面差异均无统计学意义,而Ⅳ-G组尿蛋白量(24 h)[(4.34±2.67) g比(3.52±3.46) g, P < 0.05]、临床活动指数(SLEDAI)(14.39±4.07比11.53±4.15, P < 0.05)高于Ⅳ-S组;补体C3低于Ⅳ-S组[(0.41±0.17) 比(0.46±0.16)g/L, P < 0.05]。肾脏病理方面,Ⅳ-G组免疫复合物沉积、单核巨噬细胞浸润多于Ⅳ-S组(2.11±0.54比0.35±0.39, 1.75±0.87比0.86±0.76, P均<0.05);而纤维素样坏死少于Ⅳ-S组(11.66±17.26比13.61±20.01, P < 0.05);病理活动指数Ⅳ-G 组明显高于Ⅳ-S组(9.56±3.17比6.59±2.12, P < 0.05);慢性指数低于Ⅳ-S组(4.93±1.59比5.88±2.15, P < 0.05)。14例Ⅳ-S和35例Ⅳ-G患者均应用免疫抑制剂治疗。随访1年以上,两组在尿蛋白转阴、补体达正常值、SLEDAI分值下降、Scr翻倍方面差异均无统计学意义。 结论 Ⅳ-S与Ⅳ-G两亚型在临床、病理某些方面存在差异,预后需长期随访观察。 相似文献
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目的:探讨狼疮肾炎(lupus nephritis,LN)患者的临床表现、病理、免疫学特点及其相关因素。方法回顾性分析123例 LN患者临床、病理以及实验室资料,总结 LN 的临床病理、免疫学特征以及相关因素。观察内容及实验室检查指标:患者性别、年龄、临床肾脏损害及肾外损害的临床表现、肾活检病理类型,尿常规、24 h 尿蛋白定量、血常规、血肌酐、血清胱抑素 C(cystatin C,Cys C)、血白蛋白测定及血清免疫学检查。结果①123例 LN患者中女性106例(占86.38%),男性17例(占13.82%),发病年龄14~66岁,平均年龄(32.51±11.10)岁;②临床肾损害表现以肾炎综合征型(48例,占39.02%)和肾病综合征型(42例,占34.14%)多见,无症状型33例(占26.01%),肾功能不全型20例(占16.26%);③LN病理为Ⅳ型者59例(占47.97%),Ⅱ型者44例(占35.77%),Ⅴ型者18例(占14.63%),Ⅲ型者2例(占1.63%)。其中男性以Ⅳ型、Ⅴ型为主(14例,占82.35%),Ⅱ型患者中女性42例,所占比例显著高于男性(39.6%比11.8%,P〈0.05);④单因素分析,脱发、口腔溃疡、浆膜腔炎、大量蛋白尿、贫血、白细胞减少、血小板减少、狼疮活动指数(systemic lupus erythe-matous disease activity index,SLEDAI)、血清 Cys C 升高分别在不同病理类型组间存在差异(P〈0.05);⑤以 LN病理、临床表现二分类进行 Logistic回归多因素分析,结果显示男性、贫血、大量蛋白尿、管型尿、血清Cys C升高者肾脏病理病变较重;⑥补体C3、C4降低者分别为80例(占65.04%)和51例(占41.46%),在病理Ⅳ型、Ⅴ型中尤为显著,Ⅳ型中C3降低者为44例(占74.57%),Ⅴ型中14例(占77.78%);抗双股DNA抗体(Anti-double stranded DAN antibody,抗 dsDNA抗体)、抗核小体抗体(Anti-nucleosome antibody,AnuA)、抗组蛋白抗体(Anti-histone antibody,AHA)三种抗体均阳性的患者共33例,其病理类型? 相似文献
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狼疮肾炎的病理与临床分析 总被引:1,自引:0,他引:1
目的探讨狼疮性肾炎(LN)的病理类型与临床及实验室检查的关系。方法对34例狼疮性肾炎患者进行肾活检及病理分型,分析各病理类型的临床特点、实验室检查特点、临床活动性及肾脏病理活动性。结果病理类型Ⅳ型最多见(占55.9%),Ⅳ型LN肾功能不全及血尿发生率高,肾脏病理活动性明显;Ⅳ型、Ⅴ型、Ⅴ+Ⅳ、Ⅴ+ⅢLN肾病综合征、大量蛋白尿发生率高。肾脏病理活动指数与系统性红斑狼疮的临床活动性及抗dsDNA抗体阳性率无相关性。结论狼疮性肾炎的病理类型与临床表现、实验室检查有一定联系;但二者之间关系不确定。 相似文献
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中西医结合诊治系统性红斑狼疮及狼疮肾炎的经验与体会 总被引:4,自引:0,他引:4
系统性红斑性狼疮(SLE)有肾损害者称为狼疮性肾炎(LN).事实上,几乎所有SLE患者的肾组织上都存在肾病变,病变明显者多提示疾病处于活动期.16年来,我科收治LN资料较完整的患者243例,现就其诊断和治疗问题,介绍如下. 相似文献
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152例V型狼疮肾炎的临床病理研究 总被引:6,自引:0,他引:6
目的 研究V型狼疮肾炎(LN)两种病理亚型的临床特点及其转归。方法 152例经肾穿刺活检确诊的V型LN,根据是否伴有肾小球系膜增生性病变。分为Va(61例),Vb(91例)两种亚型,分析其临床病理特点,并与同期的488例Ⅳ型LN作比较。结果 Vb型高血压,贫血,肾功能减退的发生率及低补体血症,抗dsDNA抗体阳性率明显高于Va型,与Ⅳ型接近。肾活检病理Vb型肾小球节段襻坏死,微血栓比例高于Va型,免疫复合物沉积强于Va 型。在行重复肾活检的11例Va型,13例Vb型中分别有2例(18.2%)和8例(61.5%)转为Ⅳ型LN(P<0.05)。随访1年以上的47例Va型,66例Vb型中分别有3例(6.4%)和10例(15.2%)出现血肌酐倍培。结论 Va型患者不仅肾组织损害轻,而且肾外表现较少。与之相比,Vb型临床特征更接近于Ⅳ型,部分患者可以转化为Ⅳ型,预后比Va型差。 相似文献
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目的:探讨不同病理类型狼疮性肾炎(LN)的临床表现、实验室及免疫学特征。方法:回顾性分析147例不同病理类型 LN 的临床表现、实验室及免疫学指标,并进行统计学分析比较。结果:(1)LN 最常见临床表现为浮肿73例(49.7%)、关节炎66例(44.9)%和皮疹65例(44.2)%,而Ⅲ型 LN 患者浮肿及脱发比例较Ⅳ型高,差异有统计学意义(P ﹤0.05);(2)Ⅳ型 LN 的血肌酐,WBC、Hb、PLT 损伤较Ⅴ型重、补体更低,平均动脉压比Ⅴ型高,差异有统计学意义(P ﹤0.05);Ⅴ型的胆固醇、三酰甘油较Ⅲ型和Ⅳ型明显升高;Ⅴ+Ⅲ型尿蛋白较突出,较Ⅲ型和Ⅳ型明显高,差异均有统计学意义(P ﹤0.05);(3)自身抗体在 LN 中阳性率较高的依次为 ANA 126例(85.7%),抗- dsDNA 90例(61.2%),抗- SSA 89例(60.5%);而Ⅴ+Ⅲ型及Ⅴ+Ⅳ型抗- U1RNP 阳性率分别为10例(90.9%)和11例(68.7%),较Ⅲ型和Ⅳ型明显高,差异有统计学意义(P ﹤0.05)。结论:本组病例以Ⅳ型 LN 为主;不同病理类型 LN 各具一些临床、实验室及免疫学特征;浮肿是 LN最常见的临床表现;复合Ⅴ型患者抗- U1RNP 阳性率较高。应注意Ⅴ型复合型的临床、免疫特征,可能预示发病机制不同,指导临床诊治,判断预后。 相似文献
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目的 探讨抗核小体抗体(AnuA)阳性的狼疮肾炎(LN)的临床病理特征.方法 回顾分析2004至2011年我院肾穿刺活检确诊的481例LN患者的临床表现及肾脏病理.用免疫印迹法测定患者血清中的AnuA,分为阳性组(n=76)和阴性组(n=405),比较两组的流行病学、临床表现、肾脏病理、疾病活动度之间的差异.结果 阳性组男15例,女61例,男性占19.74%,年龄(27.99±10.88)岁.阴性组男45例,女360例,男性占11.11%,年龄(31.15±12.15)岁.阳性组发病年龄早且男性多见(P<0.05);口腔溃疡、发热、贫血、低补体血症发生率、dsDNA抗体阳性率高于阴性组(P<0.05).阳性组弥漫增生性狼疮肾炎(Ⅳ型)比例及病理活动指数(AI)评分均显著高于阴性组(均P< 0.05);其他病理类型比例、慢性指数(CI)评分、SLEDAI评分两组间差异无统计学意义.结论 AnuA阳性的LN具有一定的临床病理特征,可作为增生性狼疮肾炎的生物学标记. 相似文献
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The International Society of Nephrology and Renal Pathology Society Working Group revised the histopathological classification of lupus nephritis (LN) in 2003. We studied the clinical outcome of 39 children (85% female) aged 3.3-18.0 (median 13.7) years who underwent 49 percutaneous renal biopsies at 0.1-7.8 (median 1.0) years from diagnosis of systemic lupus erythematosus (SLE) at our centre over 10 years. All renal biopsies were reviewed and reclassified according to the new criteria by one histopathologist: 2%, 13%, 15%, 51% and 20% of all cases were classes I-V, respectively (with no cases of class VI LN) and 12% overlap cases (4% classes III and V, 8% classes IV and V). Patients were followed up for 1.3-15.4 (median 5.5) years with renal and overall survival rates of 90% and 92%, respectively. Half of the children with LN have features of class IV LN, with diffuse global (class IV-G) LN associated with the worst clinical outcome and the three most severe cases of chronic renal failure with estimated glomerular filtration rates (GFRs) <25 ml/min per 1.73 m(2) in patients with diffuse global sclerosing [class IV-G(C)] LN. The new classification allows expanded histopathological grading of LN with further delineation of classes III and IV with activity and chronicity indices. 相似文献
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Gabriella Moroni Beniamina Gallelli Silvana Quaglini Giovanni Banfi Emilio Rivolta Piergiorgio Messa Claudio Ponticelli 《Nephrology, dialysis, transplantation》2006,21(6):1541-1548
BACKGROUND: Whether corticosteroid and immunosuppressive therapy may be safely withdrawn in patients with proliferative lupus nephritis is still unclear. METHODS: In 32 patients with biopsy-proven proliferative lupus nephritis previously put into remission, therapy was gradually tapered off. RESULTS: When immunosuppressive therapy was stopped (median: 38 months; 25th-75th percentile: 24-81 months, after biopsy), 24 patients were in complete remission and eight had a median proteinuria of 1.05 g/24 h (25th-75th percentile: 0.91-1.1 g/24 h) with normal renal function. After stopping therapy, patients were followed for a median of 203 months (25th-75th percentile: 116-230 months). Fifteen patients (Group 1) never developed lupus activity. The other 17 patients (Group 2) developed lupus exacerbations in a median of 34 months (25th-75th percentile: 29-52 months) after stopping therapy and were re-treated. The only significant differences between the two groups were the longer median durations of treatment, 57 months (25th-75th percentile: 41.5-113.5 months) vs 30 months (25th-75th percentile: 18-41 months; P<0.009), and remission, 24 months (25th-75th percentile: 18-41) vs 12 months (25th-75th percentile: 7-20 months; P<0.02), before stopping therapy in Group 1 than in Group 2. At last follow-up, 12 patients of Group 1 were in complete remission, two had mild proteinuria and one had died. In Group 2, one patient died, 14 were in complete remission, one had mild proteinuria and in another patient serum creatinine doubled. CONCLUSIONS: Some patients with severe lupus nephritis who enter stable remission can be maintained without any specific treatment for many years. Those patients who have new flares can again go into remission with an appropriate treatment. The longer the treatment and remission before withdrawal, the lower the risk of relapse. 相似文献
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环磷酰胺(CTX)静脉间断冲击治疗是狼疮肾炎重要的治疗方法.为观察其近、远期不良反应,我们对52例接受CTX静脉冲击治疗的狼疮肾炎患者随访10年,总结相关资料,以期为今后的治疗提供经验. 相似文献
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Zappitelli M Duffy C Bernard C Scuccimarri R Watanabe Duffy K Kagan R Gupta IR 《Pediatric nephrology (Berlin, Germany)》2004,19(5):503-510
Over the past 10 years, at our center, 25 children diagnosed with systemic lupus erythematosus (SLE) have undergone an early renal biopsy; 15 underwent a second biopsy. The objective of this study was to determine whether clinical and laboratory parameters used to evaluate lupus disease activity and nephritis correlated with the WHO class on biopsy. At diagnosis, the presence of proteinuria, hematuria, a lower serum albumin, and the need for blood pressure medication were all associated with a worse class of lupus nephritis (P<0.05). On follow-up biopsy, however, none of these parameters correlated with the WHO class. Thus, it appears that while the WHO classification is useful for categorizing disease at presentation, it may be less useful for the evaluation of disease progression. Other biopsy indices need to be evaluated in serial renal biopsies to better understand the progression of lupus nephritis once treatment has been initiated. 相似文献
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Determination of urinary albumin excretion by radioimmunoassay in patients with subclinical lupus nephritis 总被引:2,自引:0,他引:2
In an attempt to evaluate subclinical lupus nephropathy, we determined the level of urinary albumin by radioimmunoassay in 27 patients with systemic lupus erythematosus (SLE) who had no evidence of clinical renal involvement. The ratio of urinary albumin to urinary creatinine (Ualb/Ucreat X 100) was significantly higher in patients with SLE (2.56 +/- 2.71) than in normal controls (0.83 +/- 0.72). A significant decrease of urinary albumin level in response to steroid therapy was demonstrated in 5 patients examined repeatedly before and during steroid treatment. In one patient who had two episodes of exacerbations of the disease the urinary albumin level increased parallel with a worsening of the serological data and the appearance of clinical proteinuria followed. It is concluded that many SLE patients even without clinical renal involvement have pathologic albuminuria and the determination of the urinary albumin level by radioimmunoassay in these patients is useful for the management of the disease. 相似文献
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目的 探讨并发神经精神狼疮(NPSLE)的狼疮肾炎(LN)患者的生存率及其影响因素。 方法 收集78例并发NPSLE的LN患者的临床及实验室资料,共59个变量。对患者进行随访,随访起点为NPSLE起病,随访终止目标为患者因系统性红斑狼疮(SLE)或其并发症死亡,平均随访时间(53.26±44.32)月。用Kaplan-Meier法计算累积生存率,并以Cox回归模型进行影响因素分析。 结果 78例患者中16例(20.5%)因SLE或其并发症死亡。感染为最常见的死亡原因,占31.3%。患者1年、3年、5年和10年的累计总生存率分别为83.2%、81.7%、76.7%和76.7%。对生存率有影响的危险性因素为高血压(RR = 6.965,95%CI:1.578~30.746,P = 0.010)、肺部感染(RR = 8.171,95%CI:1.954~34.177,P = 0.004)及急性肾衰竭(RR = 6.978,95%CI:2.063~23.609,P = 0.002);保护性因素为环磷酰胺(CTX)冲击治疗(RR = 0.130,95%CI:0.031~0.541,P = 0.005)和NPSLE治疗缓解(RR = 0.169,95%CI:0.042~0.679,P = 0.012)。 结论 感染是并发NPSLE的LN患者最常见的死亡原因。并发NPSLE的LN患者的生存率低于单纯发生LN或NPSLE患者的生存率。高血压、肺部感染及急性肾衰竭是死亡的危险因素;CTX冲击治疗和NPSLE治疗缓解能降低病死率,改善预后。 相似文献