抗核小体抗体阳性的狼疮肾炎临床病理分析

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.

Clinicopathological analysis of lupus nephritis with antinucleosome antibody

Objective To explore the clinicopathological characteristics of lupus nephritis (LN) with antinucleosome antibody (AnuA). Methods Data of 481 patients with biopsy-proven LN in the First Affiliated Hospital of Zhengzhou University from 2004 to 2011 were analyzed retrospectively. The patients were divided into two groups: AnuA-positive group (76 patients) and AnuA-negative group (405 patients). The clinical manifestations, laboratory examinations, histopathologic classes of LN, disease activity measured by SLE disease activity index (SLEDAI) of two groups were investigated and compared. Results There were 15 male patients in positive group (15/76, 19.74%) with mean age of (27.99±10.88) years and 45 patients in negative group (45/405, 11.11%) with mean age of (31.15±12.15) years respectively, which showed that male patients were more common in positive group (P＜0.05). Incidences of oral ulcer, fever, anemia, low complement and positive anti-dsDNA antibody were higher in positive group (P＜0.05). Percentage of diffuse proliferative lupus nephritis(class Ⅳ) and pathological activity index (AI) in positive group were higher compared to negative group (all P＜0.05), while no significant differences of other pathological types, chronic index (CI) and SLEDAI were found between two groups. Conclusion LN patients with positive AnuA have special clinicopathological characteristics and AnuA may be used as a promising biomarker for the proliferative LN.