狼疮性肾炎蛋白尿水平与肾小球病理改变的关系  

Correlation of proteinuria and renal pathological lesion in lupus nephritis patients

作　　者：钟翔 李欣忆 张萍[1] 洪大情[1] 李贵森[1] 王莉[1] 邹玉蓉[1] ZHONG Xiang;LI Xinyi;ZHANG Ping;HONG Daqing;LI Guisen;WANG Li;ZOU Yurong(Department of Nephrology,Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital,Chengdu,610072,China)

机构地区：[1]四川省医学科学院.四川省人民医院肾脏内科暨肾脏病研究所,成都610072

出　　处：《肾脏病与透析肾移植杂志》2018年第5期407-411,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金项目(81300618);四川省卫计委基金(17PJ058)

摘　　要：目的:研究狼疮性肾炎(LN)患者蛋白尿水平与肾小球病理改变的关系。方法:回顾性研究121例LN患者临床和病理资料,分析24h尿蛋白定量与肾组织病理损伤的相关性。结果:121例LN患者各病理类型之间24h尿蛋白定量差异显著(P<0. 05)。24h蛋白尿水平与新月体(P=0. 049)、上皮下ED物沉积(P<0. 001)、足细胞病变的程度(P<0. 001)正相关,与系膜细胞和基质增生伴系膜区ED物沉积、内皮细胞增生、内皮下ED物沉积不相关;在校正性别、年龄、体质量指数、血清白蛋白后,多元线性回归分析提示足细胞病变程度是影响24h尿蛋白定量的唯一因素(P<0. 001),且24h尿蛋白水平对于足细胞的病理损伤程度具有预测价值(AUC 85. 5%,P<0. 001),其特异度为100%,灵敏度为42. 6%。结论:LN患者尿蛋白水平与肾脏病理改变中的足细胞损伤程度有关,蛋白尿程度随着足细胞损伤或基底膜破坏程度加重而增加;且24h尿蛋白水平对于足细胞的病理损伤程度具有较高的预测价值。Objective：To investigate the correlation of proteinuria and renal lesion in lupus nephritis （LN） patients. Methodology： Clinical and pathological data of renal biopsy proven LN patients were collected from May 1,2008 to March 1,2014 from our renal pathology database.Correlation analysis was made between the different types of renal injury in LN and proteinuria. Results：There were significant differences between 24h proteinuria and the six pathology types in the 121 LN patients （ P〈 0.05）.The level of 24 hours proteinuria was related to the degree of crescent （ P = 0. 049 ）, the degree of subepithelial electron-dense deposits （P〈0. 001） and the degree of podocyte lesion（ P〈0. 001 ）.And these three renal lesions were all positively correlated with proteinuria.There was no statistical difference between 24h proteinuria and the deposition of electron dense substance in mesangial area, mesangial cells and matrix hyperplasia, endothelial cell proliferation and subendothelial electron-dense deposits. After controlling the constant parameters of sex, age, BMI, ALB, multivariate linear regression analysis suggested that the degree of podocyte lesion was the only factor which was correlated with the 24h proteinuria （P〈0. 001 ）.The level of 24h proteinuria had a predictive value for the degree of podocyte injury （AUC 85.5%, P〈 O. 001）, and its specificity was 100%, and the sensitivity was 42. 6%. Conclusion： The level of proteinuria in LN patients is related to the degree of podocyte injury in renal pathological changes.The degree of proteinuria increases with the increase of podocyte injury or basilar membrane destruction. The level of 24h proteinuria has a high predictive value for the histopathological damage of the podocyte.

关 键 词：狼疮性肾炎 蛋白尿 足细胞 

分 类 号：R593.242[医药卫生—内科学]