147例狼疮性肾炎临床病理、实验室及与免疫学特征分析  

Analysis on Clinical,and Pathological and Immunological Features of 147 Cases with Lupus Nephritis

作　　者：邹玉蓉[1] 张萍[1] 李贵森[1] 洪大情[1] 汪伟[1] 王莉[1] 

机构地区：[1]四川省医学科学院,四川省人民医院肾内科,成都610071

出　　处：《中国中西医结合肾病杂志》2014年第8期686-689,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：四川省卫生厅科研项目(No.110227)

摘　　要：目的:探讨不同病理类型狼疮性肾炎(LN)的临床表现、实验室及免疫学特征。方法:回顾性分析147例不同病理类型LN的临床表现、实验室及免疫学指标,并进行统计学分析比较。结果:(1)LN最常见临床表现为浮肿73例(49.7%)、关节炎66例(44.9)%和皮疹65例(44.2)%,而Ⅲ型LN患者浮肿及脱发比例较Ⅳ型高,差异有统计学意义(P<0.05);(2)Ⅳ型LN的血肌酐,WBC、Hb、PLT损伤较Ⅴ型重、补体更低,平均动脉压比Ⅴ型高,差异有统计学意义(P<0.05);Ⅴ型的胆固醇、三酰甘油较Ⅲ型和Ⅳ型明显升高;Ⅴ+Ⅲ型尿蛋白较突出,较Ⅲ型和Ⅳ型明显高,差异均有统计学意义(P<0.05);(3)自身抗体在LN中阳性率较高的依次为ANA 126例(85.7%),抗-dsDNA 90例(61.2%),抗-SSA 89例(60.5%);而Ⅴ+Ⅲ型及Ⅴ+Ⅳ型抗-U1RNP阳性率分别为10例(90.9%)和11例(68.7%),较Ⅲ型和Ⅳ型明显高,差异有统计学意义(P<0.05)。结论:本组病例以Ⅳ型LN为主;不同病理类型LN各具一些临床、实验室及免疫学特征;浮肿是LN最常见的临床表现;复合Ⅴ型患者抗-U1RNP阳性率较高。应注意Ⅴ型复合型的临床、免疫特征,可能预示发病机制不同,指导临床诊治,判断预后。Objective：To explore the clinical、pathological and immunological features with different pathological types of lu-pus nephritis（LN）patients. Methods：The clinical、pathological and immunological material of 147 cases with LN were analyzed ret-rospectively and was analyzed by statistical method. Results：（1）The most common clinical symptoms of LN included was edema 73 cases（49. 7% ）,arthralgia 66cases（44. 9% ）and rash 65 cases（44. 2% ）. Compared to other class LN,class Ⅲ had higher inci-dence of edema and hair loss,the difference was statistically significant（P ﹤ 0. 05）;（2）Compared to class Ⅴ,the class Ⅳ had more severely changed on the average Crea,WBC,HGB,PLT ,and moer lower complement levels,more higher MAPmean arterial pres-sure,the difference was statistically significant（P ﹤ 0. 05）;Compared to class Ⅲ and Ⅳ,the averge cholesteroland triglycerides lev-els of classⅤ was significantly higher（P ﹤ 0. 05）,24 h urinary protein excretion of classⅤ ＋ Ⅲ was more higher（P ﹤ 0. 05）;（3） The positive rates of autoantibodies in LN patients were relatively high level on ANA 126 cases（85. 7% ）,anti - dsDNA 90 cases （61. 2% ）,anti - SSA 89 cases（60. 5% ）;compared with classⅢ and classⅣ,class Ⅴ ＋ Ⅲ and class Ⅴ ＋ Ⅳ anti - U1RNP posi-tive rates were significantly higher,Respectively was 10 cases（90. 9% ）and 11 cases（68. 7% ）,the difference was statistically sig-nificant（P ﹤ 0. 05）. Conclusion：LN class Ⅳ was the most common type in this study;The LN with different pathological class has some of the characteristics of clinical,laboratory and immunological features;Edema is the most common clinical symptoms on LN;LN Complex Ⅴ has more higher anti - U1RNP positive rates than others. We should pay attention to the clinical,immunological char-acteristics of complex class Ⅴ,It may indicate different pathogenesis,and guide clinical diagnosis and treatment,judge prognosis.

关 键 词：狼疮性肾炎 肾脏病理 临床表现 免疫学特征 

分 类 号：R593.241[医药卫生—内科学]