狼疮肾炎281例临床病理分析

目的 探讨狼疮肾炎(LN)临床表现、实验室检查与肾脏病理改变的特点及其相关性.方法 根据LN的最新病理学分类标准,收集整理281例经肾活检确诊的LN患者的临床病理资料,分析其临床表现、实验室检查和肾脏病理改变及其相关性.结果 281例患者中,男:女为1∶9.7.临床表现以蛋白尿合并血尿(35.2%)、肾病综合征(33.8%)为主.病理表现以Ⅳ型(35.9%)、Ⅴ型(15.7%)占多数,Ⅲ+Ⅴ和Ⅳ+Ⅴ型亦较多,Ⅲ、Ⅳ、Ⅴ型共占总数的89.0%.临床表现为.肾病综合征者主要病理改变为Ⅳ型和Ⅴ型,合并肾功能不全者主要为Ⅵ型和Ⅳ型,单纯血尿者病理改变较轻.47例尿蛋白定量(24 h)少于1.0 g且肾功能正常者中Ⅳ、Ⅴ型合计占40.4%.尿蛋白定量(24 h)以Ⅴ型最高,血肌酐和抗双链DNA(dsDNA)抗体水平以Ⅵ型和Ⅳ型较高,血补体C3水平以Ⅳ型最低.尿蛋白定量(24 h)与血C3呈负相关、与血肌酐呈正相关;血C3与抗dsDNA抗体和肌酐呈负相关;血肌酐和抗dsDNA抗体呈正相关.结论 本组LN病理改变以Ⅲ、Ⅳ、Ⅴ型为主.临床表现与肾脏病理改变有一定相关性,但亦可能不符.某些实验室指标之间及与肾脏病理改变之间存在一定相关性.尿蛋白增多、血C3下降、抗dsDNA抗体升高提示LN的严重性和活动性.肾活检对LN的诊断以及病情判断意义重大.

Clinicopathulogic correlation in lupus nephritis:281 eases analysis

Objective To investigate the clinical manifestations,laboratory findings and renal patho logic changes,as well as their relationships in patients with lupus nephritis (LN).Methods According to the latest classification criteria of lupus nephritis,the clinical manifestations,laboratory findings and renal patho logic changes and their relationships of 281 cases of biopsy proven LN were retrospectively analyzed.Results Totally 281 cases of LN patients were enrolled in total.The ratio of male to female was 1∶9.7.Proteinuria ac companied with hematuria (35.2%) and nephrotie syndrome (33.8%) were the main clinical manifestations. The most common renal pathological change was type Ⅳ LN (35.9%) and type Ⅲ,Ⅳ and Ⅴ accounting for 89.0% totally.The main pathologic changes of nephrotic syndrome were type Ⅳ and Ⅴ,while those who ac companied with renal dysfunction were mainly type Ⅵ and Ⅳ.Most simple hematuria cases showed mild renal injury.However,type Ⅳ and Ⅴ accounted for 40.4% in the 47 cases of LN whose 24 hours urine protein＜ 1.0 g and with normal renal function.Most severe proteinuria was found in Type Ⅴ and higher serum creatinine and anti-dsDNA antibody level were found in type Ⅵ and Ⅳ.The lowest lever of serum complement 3 (C3) was found in type Ⅳ.The amount of 24 hours urine protein showed negative correlation with semm C3 but positive correlation with serum creatinine.Serum C3 demonstrated negative relationship with serum creatinine and anti-dsDNA antibody,while serum creatinine was positively related to anti-dsDNA antibody level. Conclusion The major renal pathological lesions of LN are type Ⅲ,Ⅳ and Ⅴ.There are associations be tween clinical and pathological changes,but axe not always consistent.Proteinuria,low serum C3 and high an ti-dsDNA antibody level may provide clue to severe and active LN.Renal biopsy is important in the diagnosis and progression evaluation of LN.