快速进展性狼疮性肾炎临床病理特征及预后研究  

Clinicopathological features and renal prognosis of severe lupus patients with rapidly progressive glomerulonephritis

作　　者：陈莎莎[1] 唐政[1] 刘正钊[1] 章海涛[1] 胡伟新[1] 刘志红[1] 

机构地区：[1]南京大学医学院南京军区南京总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《中国实用内科杂志》2015年第2期146-150,共5页Chinese Journal of Practical Internal Medicine

基　　金："十一五"国家科技支撑计划课题(2011BAI10B04)

摘　　要：目的明确快速进展性狼疮性肾炎(LN)的临床病理特征及预后。方法回顾性分析南京军区南京总医院2003—2013年收治的101例临床表现为急进性肾炎综合征(RPGN)且经肾活检证实为重症LN患者的临床资料,并以同期不表现为RPGN的200例重症LN患者作为对照,比较两组患者临床病理资料及预后。结果 101例RPGN患者中男25例,女76例;肾活检时平均年龄为(31.9±14.2)岁;中位随访时间为4年。与对照组相比,RPGN组病程更短、肌酐更高、贫血更重、血尿较多,肾小管损伤指标(NAG、RBP、C3)更高,活动指数(AI)和慢性指数(CI)更高,肾小球硬化和新月体比例更高,肾小管间质病变和间质炎症更重,完全缓解率较低(33.9%对68.2%),失败率较高(46.8%对7.9%)(均P<0.05)。RPGN和非RPGN组患者肾活检术后3,5和10年的累积肾脏存活率分别为65.1%对96.9%,53.9%对94.9%,42.9%对91.7%。多因素Cox回归分析显示,血肌酐浓度和新月体的比例是影响RPGN进入终末期肾病的最重要的危险因素(均P<0.001)。结论快速进展性LN患者强调早期诊断、早期治疗,血肌酐>256.4μmol/L或肾活检光镜下新月体>59.7%患者预后较差,肾功能恢复可能较小。Objective To clarify the long-term outcome and renal prognosis in lupus nephritis（LN） patients with rapidly progressive glomernlonephritis（RPGN）. Methods One hundred and one cases of biopsy-proven severe LN with RPGN were analyzed in this retrospective study. Another 200 severe LN patients without RPGN were randomly enrolled as a control group. Their clinicopathological data and long-term outcome were compared. Results There were 76 females and 25 males with an average age of （31.9±14.2）years followed for a median period of 4 years. Compared with controls,patients with RPGN had short LN duration（P=0.008）,high level of creatinine （P〈0.001）,severe anemia（P=0.037）,heavy hematuria（P〈0.001）,severe tubular injury parameters（NAG,RBP, C3） （all P〈0.001）,high scores ofAI（V=0.001）and CI（P=0.004）,high proportions of glomerular sclerosis（0.033）and crescents（P〈0.001）,severe tubulointerstitial lesions（P〈0.001）and interstitial inflammation（P〈0.001）,low rate of complete remission（33.9% vs. 68.2%）and high rate of treatment failure（46.8% vs. 7.9%）. The 3-,5-and 10-year cumulative renal survival rates of RPGN and non-RPGN patients were 65.1% vs. 53.9% vs. 42.9% and 96.9% vs. 94.9% vs 91.7%,respectively. Multivariate analysis revealed that SCr concentration and the proportion of crescents were the most important risk factors for end-stage renal disease in severe LN with RPGN（P〈0.001）. Conclusion Rapidly progressive LN must be diagnosed promptly and precisely so that appropriate treatment can be initiated as quickly as possible. Patients with SCr ≥256.4 μmol/L or crescents ≥59.7% were less likely to recover from renal failure.

关 键 词：新月体 狼疮性肾炎 急进性肾小球肾炎 

分 类 号：R593.242[医药卫生—内科学]