狼疮性肾炎病理类型与临床特点的相关性研究

目的：探讨狼疮性肾炎（lupus nephritis,LN）病理类型与其临床特点的相互关系。方法：回顾性总结2008～2009年在我院住院并行肾活检的100例LN患者的临床资料特点,肾活检病理分型按照2003年ISN/RPS分型方案,对LN病理类型与临床特点进行分析。结果：①各病理类型比例分别为Ⅰ型6%（6/100）,Ⅱ型28%（28/100）,Ⅲ型9%（9/100）,Ⅳ型42%（42/100）,Ⅴ型9%（9/100）,Ⅴ＋Ⅳ6%（6/100）。②Ⅰ型LN主要表现为隐匿性肾炎（占66.7%）,Ⅱ、Ⅲ、Ⅴ型LN主要表现为肾炎综合征（分别占75%、66.7%和66.7%）,Ⅳ、Ⅴ＋Ⅳ型LN主要表现为肾病综合征（分别占71.4%和66.7%）。肾功能不全型的发生率为29%,主要见于Ⅳ型LN。③各病理类型组间SLEDAI评分差异无统计学意义（P〉0.05）。高血压主要出现在Ⅳ型（P〈0.05）,水肿主要出现在Ⅳ、Ⅴ、Ⅴ＋Ⅳ型,余临床表现与各病理类型之间无明显的相关性（P〉0.05）。结论：LN病理类型以Ⅳ型最常见;Ⅰ型LN临床上主要表现为隐匿性肾炎,Ⅱ、Ⅲ、Ⅴ型LN主要表现为肾炎综合征,Ⅳ、Ⅴ＋Ⅳ型LN主要表现为肾病综合征,Ⅳ型LN较易发生肾功能不全;高血压多见于Ⅳ型LN。

STUDY ON THE PATHOLOGICAL TYPE AND CLINICAL CHARACTERISTICS IN LUPUS NEPHRITIS

Objective：To investigate the clinical characteristics,lupus disease activity index（SLEDAI） and the relationship among them of different pathological types in lupus nephritis（LN）,which had renal biopsy.It can help to understand the nature of LN,and provide the basis for the treatment.Methods：A total of 100 LN patients were included in this study,who were choosed in the first affiliated hospital of Guangxi Medical University in 2008～2009 and had renal biopsy.Clinical data were collected from the history records.The histological classifications were categorized according to 2003 ISN/RPS classification.SLEDAI were scored.Results：①The pathological types included typeⅠ 6%（6/100）,typeⅡ28%（28/100）,type Ⅲ 9%（9/100）,type Ⅳ 42%（42/100）,type Ⅴ9%（9/100） and typeⅤ＋Ⅳ 6%（6/100）.②typeⅠ LN was mainly expressed in latent nephritis syndrome（66.7%）,types Ⅱ,Ⅲ and Ⅴ LN were mainly expressed in nephritic syndrome（75%,66.7% and 66.7%;respectively）,types Ⅳ and Ⅴ ＋ Ⅳ LN were mainly expressed in nephrotic syndrome（71.4% and 66.7%;respectively）.③SLEDAI score among the three groups was no significant difference（P0.05）.HBP was mainly seen in the type Ⅳ（P0.05）;other clinical manifestations of the pathological types were no significant difference（P 0.05）.Conclusion：①Type Ⅳ is the most common of all pathological LN types（42%）.②TypeⅠLN is mainly expressed in latent nephritis,types Ⅱ,Ⅲ and Ⅴ LN are mainly expressed in nephritic syndrome,types Ⅳ and Ⅴ ＋ Ⅳ LN are mainly expressed in nephrotic syndrome.Renal insufficiency of type Ⅳ LN is more prone to incident.③HBP is more common in type Ⅳ LN;there is no significant correlation between LN pathological types and other clinical manifestations.