104例儿童系统性红斑狼疮肾炎临床及病理分析

目的:了解狼疮肾炎患儿临床与病理特征的关系。方法:对2000年1月至2010年4月确诊为狼疮性肾炎患儿的临床和病理资料进行回顾性分析。结果:(1)104例中,男女比例为1∶4.2,9～15岁为高发年龄。(2)系统性红斑狼疮初诊即有肾脏受损者98例(94.23%)。(3)共40例行肾活检,各种病理类型均可出现,以Ⅳ型多见,占57.50%,其次是Ⅱ型(22.50%)和Ⅴ+Ⅲ型(7.50%),尿改变以蛋白尿多见。其临床分型中,肾病综合征最多见(12例,30.00%)。临床分型与病理类型之间无对应关系(χ2=37.365,P=0.139)。(4)SLEDAI评分(病情活动度)与AI(活动指数)呈正相关(P=0.014),与病理类型无相关性。结论:儿童狼疮肾炎病理类型与临床分型无对应关系,故及时肾活检,有利于及时治疗,改善预后。

The Clinical and Pathological Analysis of 104 Cases of Children's Lupus Nephritis

Objective: The purpose was to understand the relationship between clinical and pathological characteristics of children’s lupus nephritis(LN).Methods: We Collected the clinical and pathological medical records of children with lupus nephritis from January 2000 to April 2010,and performed a retrospective analysis.Results:(1) Among 104 cases,the male to female ratio was 1∶4.2.The peak age of morbidity ranged from 9 to 15 years old.(2) Together 98 children(94.23%) with systemic lupus erythematosus(SLE) had urinary or renal function abnormalities when first diagnosed.(3) Forty patients received renal biopsy,23 cases(57.50%) were Class IV nephritis,which was the most frequent histopathology,followed by class II(22.50%) and V+III(7.50%).Nephrotic syndrome was the most frequent clinical manifestation,accounting for 30.00%(12 cases) of all clinical types.There was no significant distinction in the distribution of pathological classifications among various clinical types(χ2=37.365,P=0.139).(4) SLEDAI score(disease activity) was correlated to AI(activity index)(P=0.014),but not correlated to pathological classifications(F=1.62,P=0.212).Conclusions: There is no correlation between pathological classifications and clinical types of children’s lupus nephritis.So timely renal biopsy could help patients to get timely treatment and to improve the prognosis.