系统性红斑狼疮合并抗磷脂抗体相关性肾病的肾组织病理学特点  

Renal histopathologic characteristics of antiphoslipid antibody-associatednephropathy in patients with Systemic Lupus Erythematosus

作　　者：高瑞通[1] 俞文清[1] 文煜冰[1] 李雪梅[1] 郑法雷[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730

出　　处：《基础医学与临床》2011年第12期1387-1391,共5页Basic and Clinical Medicine

基　　金：国家(重点)实验室专项经费(2060204);北京协和医院2010年度院内青年基金(2010129)

摘　　要：目的分析系统性红斑狼疮(SLE)患者合并抗磷脂抗体相关性肾病(APLN)的肾组织病理学表现,以促进对APLN的认识。方法回顾性分析北京协和医院2000—2005年期间155例SLE肾活检患者中APLN及APLN样肾组织病理学表现特点,及其与APL的关系。分为2组:抗磷脂抗体(APL)阳性组37例(23.9%)和APL阴性组118例(76.1%)。结果 155例SLE患者中APLN及APLN样肾组织病理学表现共55例(35.5%),包括急性表现即血栓性微血管病(9.0%)和慢性表现(29.7%)。慢性表现中纤维性肾内动脉增生46例(29.7%)、纤维性或细胞纤维性肾内动脉阻塞12例(7.7%)、局灶性肾皮质萎缩共3例(1.9%)、肾小管甲状腺样化8例(5.2%)。其中APL阳性组的APLN肾组织病理学表现共23例,占阳性组62.1%,APL阴性组共32例占阴性组27.1%,Logistic回归分析表明,APL阳性组的APLN肾组织学表现发生率(62.1%vs 27.1%)及慢性表现和急性表现的发生率均显著高于APL阴性组(P<0.05)。结论 SLE患者合并APLN的肾组织病理学表现发生率较高,APLN的肾组织病理学表现与APL存在显著相关性。Objective To investigate the renal histopathologic characteristics of antiphoslipid antibody-associated nephropathy（APLN） in patients with Systemic Lupus Erythematosus（SLE）. Methods Data of 155 cases of SLE admitted to Peking Union Medical College Hospital from 2000 to 2005 was reviewed. Kidney biopsy was performed in all of these patients. Using retrospective analysis, we investigated the APLN and APLN-like renal histopathologic characteristics and its correlation with antiphsolipid antibody （APL）. Two groups including APL positive group（37 cases, 23.9% ） and APL negative group （118 cases, 76. 1% ） were compared. Results APLN and APLN-Like renal histopathologic lesions were found in 55/155 （35.5%） cases of patients with SLE. 46 cases of included fi- brous intimal hyperplasia （29. 7% ）, 12 cases of fibrous and/or fibrocelluar occlusions of arteries and arterioles （7.7%）, 3 cases of focal cortical atrophy（ 1.9% ）and 8 cases of tubular thyroidization（5.2% ） were showed in all 46/155 （29. 7% ） cases of chronic APLN and APLN - like lesion. Acute APLN and APLN - like lesions （ thromboticmicroangiopathy ） were detected in 14 cases （9. 0% ）. APLN and APLN-Iike renal histopathologic lesions of were found in 23/37（62. 1% ） cases in APL positive group and 32/118（27. 1% ） cases in APL negative group. The incidence of total renal histopathologic lesions （62. 1% vs 27. 1% ） and its chronic and acute lesions in APL positive group were all signifi- cantly higher than in APL negative group by logistic regression （P 〈 0. 05）. Conclusions High incidence of renal hi topathologic lesions of APLN was found in SLE patients. The lesions were high correlated with APL.

关 键 词：系统性红斑狼疮 抗磷脂抗体 抗磷脂抗体相关性肾病 

分 类 号：R692[医药卫生—泌尿科学]