153例狼疮性肾炎的临床与肾脏病理分析

目的分析狼疮性肾炎(LN)患者临床表现与肾脏病理改变及相关实验室检查异常之间的关系。方法回顾性分析153例LN患者的临床和病理资料,以及二者之间的关系。结果本组病例以Ⅳ型LN最多见(49%),其次是Ⅴ+Ⅳ型(13.7%),男性以Ⅳ型及Ⅴ+Ⅳ型为主,共占72.7%。与其他病理类型的患者比较,Ⅳ型及Ⅴ+Ⅳ型患者血清补体C3水平低,SLEDAI评分及肾组织病理活动性指数(AI)评分增高(P均<0.05)。狼疮活动及显著活动组抗dsDNA抗体滴度、肌酐(Scr)、AI评分与狼疮不活动组比较,有统计学差异(P<0.05),狼疮活动组血清补体C3水平及肾组织C3荧光沉积强度与不活动组比较也有统计学差异差异(P<0.05)。AI与Scr、SLEDAI评分及补体C3水平密切相关(r值分别为0.37、0.16和-0.32,P<0.05)。结论低补体血症、抗dsDNA抗体滴度和肾组织C3沉积强度是判断狼疮活动的特异性指标;Scr、SLEDAI评分和血清补体C3水平是AI评分的影响因素。

Relationship between the Clinical and Pathological Features of 153 Cases with Lupus Nephritis

Objective To analyze relationship between the clinical and pathological features of Chinese patients with lupus nephritis （LN）. Method 153 cases with LN were enrolled in this study. Retrospective analysis was done on the relationship between the clinical and pathological features . Results The proportion of class Ⅳ （49% ） was highest in this study, and that of class Ⅴ＋Ⅳ was 13.7%. class Ⅳ and class Ⅴ＋Ⅳ （72.7%） was the most common in males. The level of complement 3 （C3） was lower in class Ⅳ and class Ⅴ＋Ⅳ, campared with renal histological classes （P〈0 .05）. Class Ⅳ and class Ⅴ＋Ⅳ indicated high SLEDAI score and AI score. In the group of patients with activity and high activity of SLE, the anti-dsDNA antibody, serum creatinine （Scr） , AI score and the contents of C3 in nephridial tissue were higher and serum C3 was lower than that in patients with inactivity of SLE. There was close association of AI score with clinical features, including Scr （r=0.27, P〈0 .05）, SLEDAI （r=0.16, P〈0 .05） and C3 （r=-0.32, PHypocomplementemia, the level of anti-dsDNA antibody and the deposition of C3 in kidney are the important features in predicting the activity of SLE. Scr, SLEDAI score and serum C3 are the important factors in making AI score.