49例狼疮性肾炎尿毒症临床资料及预后分析  

Clinical Observation and Prognostic Analysis of 49 Uremic Patients with Lupus Nephritis

作　　者：陆才生[1] 叶任高[2] 曾丽霞[2] 李广然[2] 

机构地区：[1]中山医科大学附属第三医院风湿科,广州510630 [2]中山医科大学附属第一医院肾内科,广州510080

出　　处：《中国中西医结合肾病杂志》2001年第7期393-396,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：卫生部临床学科重点基金资助项目 (No .970 40 2 88)

摘　　要：目的 :分析狼疮性肾炎 (LN)尿毒症的临床特点 ,调查治疗效果及预后情况。方法 :回顾性分析了1983年 12月至 1997年 12月间 49例就诊于中山医科大学附属一院首诊为LN尿毒症的临床资料 ,门诊随诊或随访透析治疗及是否使用免疫抑制治疗的效果及预后情况。结果 :LN尿毒症病人各临床表现发生率及血清学阳性率较非尿毒症LN均明显减少 ;狼疮活动指数也明显低于非尿毒症组病人 (P <0 .0 5 ) ;有半数以上 (2 9例 )入院B超提示双肾尚未缩小 ,其中 18例有肾活检资料 ,与同期随机抽取 46例非尿毒症LN病人比较 ,其肾病理活动性指数 (AI)及慢性化指数 (CI)分布均无显著性差异 (P >0 .0 5 ) ;2 5例双肾未缩小者接受了透析及免疫抑制剂治疗 ,结果 18例能暂时脱离透析一段时间 ,从停透到再次透析平均 (14.7± 34.3)月 ;2 4例单纯透析者 ,无 1例脱离透析治疗 ;单纯透析组死亡率达 45 .8% (11/2 4) ,透析加免疫抑制组为 2 8.0 % (7/2 5 ) ;死亡原因中感染占 44 .4% (8/18) ,透析不充分占 2 2 .2 %(4 /18) ,狼疮活动占 16 .7% (3/18) ,心血管并发症达 11.1% (2 /18) ,营养不良及全身衰竭 5 .6 % (1/18)。结论 :LN尿毒症病人 ,临床狼疮活动不明显 ,但其中双肾未缩小者的肾脏病理AI及CI分布与非尿毒症LN病人并无显著性差别。Objective:To study the clinical characteristics,treatment and prognosis of uremic lupus nephritis patients.Methods:49 uremic lupus nephritis patients were included in this study.Clinical data were analyzed retrospectively and long-term follow-up was performed.Results:The prevalence of clinical and serologic manifestations and lupus activity index in uremic lupus nephritis patients were much lower than those in non-uremic patients (P<0.05 or P<0.01).More than half (29)of these patients had normal-sized kidneys on admission.Renal pathological data showed no differences is renal activity index and chronicity index between uremic and non-uremic LN patients(P>0.05).18 out of 25 patients with normal-sized kidneys who received dialysis and immunosuppression temporarily withdrew from dialysis for a mean duration of 14.7±34.3 months and the mortality of was 45.8%(11/24. No patients received dialysis alone could withdraw from dialysis and the mortarily was 28.0%(7/25).The most common cause of death was infection(40%),followed by inadequate dialysis(22.2%),lupus activity (16.7%),cardiovascular complications (11.1%)and severe malnutrition(5.6%).Conclusion:Clinical lupus activity of patients with LN decreased in uremia and there were no dramatically changes in the distribution of renal activity index and chronic index in more than half of the patients with normal-sized kidneys.On the basis of dialysis,proper immunosuppressive treatment can improve renal functions and probaly decrease the mortality in some well-selected patients,but attentions should be paid to infections during treatment.

关 键 词：狼疮性肾炎 肾衰竭 治疗方法 预后 SLE LN 尿毒症 

分 类 号：R593.242[医药卫生—内科学] R692.5[医药卫生—临床医学]