狼疮肾炎合并抗中性粒细胞胞浆抗体阳性的临床分析  

Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies

作　　者：王渊[1] 黄鑫[1] 张均[1] 刘力[1] 钱丹[1] 唐莎[1] 张莹[1] 赵景宏[1] 黄云剑[1] 张静波[1] 

机构地区：[1]第三军医大学新桥医院肾内科,重庆400037

出　　处：《第三军医大学学报》2015年第7期678-683,共6页Journal of Third Military Medical University

基　　金：第三军医大学临床科研基金(2011XLC37)~~

摘　　要：目的探讨狼疮肾炎(lupus nephritis,LN)合并抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)阳性患者的临床病理特征及预后。方法回顾性分析2011-2013年我院肾内科穿刺活检确诊的154例LN患者的临床表现及肾脏病理。采用欧蒙印迹法及间接免疫荧光法测定患者血清中的ANCA,分为ANCA阳性组和ANCA阴性组,比较两组患者流行病学、临床表现、实验室检查、肾脏病理、疾病活动度以及预后情况之间的差异。结果 ANCA阳性的LN患者26例(16.88%),其中MPO-ANCA 24例,PR3-ANCA 2例;ANCA阴性的LN患者128例。26例ANCA阳性的LN患者,脱发、口腔溃疡、光过敏及皮损的发生率明显高于ANCA阴性组(P值分别为0.007、0.016、0.022);抗核小体抗体及抗心磷脂抗体的发生率明显高于ANCA阴性组(P值分别为0.001、0.005);补体C3水平明显低于ANCA阴性组(P=0.034)。ANCA阳性组肾脏病理的肾小球球性硬化发生率及硬化比例、慢性指数(chronic index,CI)评分显著高于ANCA阴性组(P值分别为0.003、0.004、0.013),而病理类型分布、新月体形成、血管袢坏死、微血栓形成、肾小管萎缩及肾间质纤维化、活动指数(activity index,AI)评分、肾小管损伤(tubular interstitial lesion,TIL)评分、狼疮活动度(SLEDAI)评分两组间差异无统计学意义(P>0.05)。ANCA阳性组尿蛋白转阴率明显低于ANCA阴性组(χ2=7.421,P=0.006),两组间死亡率差异无统计学意义(P>0.05)。结论 ANCA阳性的LN患者易出现脱发、口腔溃疡、光过敏及皮损,肾脏病理可逆程度及预后较差,需早期积极治疗。Objective To investigate the clinicopathological features and outcomes of lupus nephritis （LN） with being positive to anti-neutrophil cytoplasmic antibodies （ANCA）. Methods Clinical data of 154 patients with LN who underwent renal biopsy in our department from January 2011 to December 2013 were collected and analyzed retrospectively. According to the results of EUROBlot and indirect immunofluoreseence staining, the patients were divided into 2 groups. ANCA-positive and ANCA-negative. The clinical manifestations, laboratory examinations results, pathologic features, systemic lupus erythematosus disease activity index （SLEDAI） and prognosis were compared between ANCA-positive and ANCA-negative groups. Results Among all the patients presented in this study, there were 26 patients （ 16.88% ） positive to ANCA [ including 24 cases positive to myeloperoxidase （MPO） -ANCA and 2 cases positive to proteinase 3 （ PR3 ） - ANCA] , and 128 LN patients negative to ANCA. The incidences of alopecia, oral ulcer, photosensitivity and skin lesion were obviously higher in the positive group than the negative one （P 〈0.007, 0. 016, 0. 022）. So were the frequencies of being positi 0. 005）. But the level of C3 was ve to anti-nucleosome antibody and anti-cardiolipin antibody （P 〈 0.001, significant lower in the former than the latter groups （ P = 0. 034）. The incidence and percentage of glomerular sclerosis and chronic index （CI） were higher in positive group than the negative group （P 〈 0. 003, 0. 004, 0. 013 ）. There were no significant differences in pathological types, activity index （AI）, tubular interstitial lesion （TIL）, SLEDAI, and severities of crescent formation, vascular loop necrosis, micro thrombosis, renal tubular atrophy and renal interstitial fibrosis between the 2 groups （P 〉 0.05）. The mortality showed no significant difference either （P 〉 0. 05）. The negative conversion rate of proteinuria was obviously lower in the positive than the negative groups

关 键 词：抗中性粒细胞胞浆抗体 狼疮肾炎 病理 预后 

分 类 号：R181.32[医药卫生—流行病学] R392.3[医药卫生—公共卫生与预防医学]