狼疮性肾炎患者血红蛋白水平与肾小球微血栓形成相关性研究  

Relationship between Hemoglobin Levels and Glomerular Microthrombosis in Patients with Lupus Nephritis

作　　者：操长春 胡豪飞 周丽[1] 魏径虹 廖德汉 朱日兴 邓志勇 吴维涛 尹盼盼 肖鸿莉 何永成[1] CAO Changchun;HU Haofei;ZHOU Li(Shenzhen Second People’s Hospital Clinical Medicine College of Anhui Medical University,Nephrology Department of Shenzhen Second People’s Hospital,Shenzhen,518037)

机构地区：[1]安徽医科大学深圳市第二人民医院临床学院,广东省深圳市第二人民医院肾内科

出　　处：《中国中西医结合肾病杂志》2019年第12期1048-1052,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：深圳市科创委基础研究项目(No.JCYJ20130329104904512);深圳市科创委技术开发项目(No.CXZZ20150601140615135,CXZZ20140421155346007);深圳市卫计委学科建设能力提升项目(No.SZXJ2017031)

摘　　要：目的:探讨狼疮性肾炎(lupus nephritis,LN)患者的血红蛋白水平与GMT形成的关系。方法:回顾性分析2010年01月1日~2018年04月30日在深圳市第二人民医院肾穿刺活检确诊为LN的患者109例,根据纳排,共100例LN患者纳入研究。按是否有肾小球微血栓(glomerular microthrombosis,GMT)形成分为有GMT形成组(GMT组)与无GMT形成组(Non-GMT组)。比较两组患者临床指标、病理指标等差异。采用logistic回归分析,探讨血红蛋白水平是否是GMT形成的独立影响因素。采用曲线拟合分析血红蛋白水平与微血栓发生率的关系。结果:与Non-GMT组相比,GMT组患者年龄大(P=0.021),血压较高(P<0.05),尿蛋白定量、血清尿酸水平增加(P<0.05),血红蛋白、血清白蛋白、eGFR、血清C3水平偏低(P<0.05)。GMT组患者病理类型更多表现为Ⅳ型LN。与Non-GMT组相比,GMT组患者病理活动指标:新月体形成、系膜细胞和基质增生、间质炎症细胞浸润、核碎裂、白金耳、内皮增生等表现更重(P<0.05)。多因素logistic回归分析发现血红蛋白水平是GMT形成的独立保护因素(OR=0.954,P=0.00016)。进一步平滑曲线分析发现血红蛋白水平与GMT呈曲线关系,血红蛋白水平越高,GMT发生率越低。分层交互作用发现狼疮活动较轻时(狼疮活动评分≤14分),LN患者的血红蛋白水平是GMT形成的独立保护因素(P<0.05)。ROC曲线结果表明,当血红蛋白水平<107.5 g/L,可作为诊断LN患者GMT形成的重要标志。结论:血红蛋白水平与GMT形成密切相关,对于诊断GMT形成具有重要价值。Objective:To investigate the relationship between hemoglobin levels and glomerular microthrombus in patients with lupus nephritis(LN).Methods:A total of 109 patients who were diagnosed as Lupus nephritis by renal biopsy from January 2010 to April 2018 in the Second Affiliated Hospital of Shenzhen University.Finally,a total of 100 patients were enrolled in this study.All patients were divided into two groups:glomerular microthrombosis group(GMT group)and Non-glomerular microthrombosis group(Non-GMT group).Logistic regression analysis were used to explore whether hemoglobin levels are independent influencing factors of glomerular microthrombosis formation.And curve fitting analysis were used to investigate the relationship between hemoglobin level and glomerular microthrombosis formation.Results:Compared with the Non-GMT group,the GMT group was older(P=0.021),with higher blood pressure(P<0.05),higher urine protein quantitation and serum uric acid level(P<0.05).But hemoglobin,albumin,eGFR and serum C3 level is lower(P<0.05).The pathological type of patients in the GMT group was more likely to be type IV LN.Pathological activity indicators,crescent formation,mesangial cell and stromal hyperplasia,interstitial inflammatory cell infiltration,nuclear fragmentation,platinum ear,and endothelial hyperplasia were more severe in the GMT group(P<0.05)compared with the Non-GMT group.Hemoglobin level is an independent protective factor of glomerular microthrombosis formation in multivariate logistic regression analysis(OR=0.954,P=0.00016).Smooth curve analysis showed that hemoglobin level was linear with glomerular microthrombosis.Higher hemoglobin level related with lower incidence of glomerular microthrombosis.Stratified analysis found that hemoglobin level was independent factors of glomerular microthrombosis formation(P<0.05)when lupus activity was mild(lupus activity score≤14 points).ROC curve results showed that when the hemoglobin level<107.5 g/L,it can be used as an important marker for diagnosing glomerular microthro

关 键 词：LN 血红蛋白 GMT 

分 类 号：R593.242[医药卫生—内科学]