狼疮性肾炎的临床病理特点及影响肾脏病理损害的危险因素分析  

The clinicopathologic features of lupus nephritis and its risk factors for renal pathological damage

作　　者：王建 孙静静 李振军 姜传学 李庆士 朱井俊 李龙海 Wang Jian;Sun Jingjing;Li Zhenjun;Jiang Chuanxue;Li Qingshi;Zhu Jingjun;Li Longhai(Department of Nephrology,Fuyang Second People's Hospital of Anhui,Fuyang 236015,China)

机构地区：[1]安徽省阜阳市第二人民医院肾脏内科,236015

出　　处：《国际泌尿系统杂志》2020年第4期672-675,共4页International Journal of Urology and Nephrology

基　　金：阜阳市2014年科立项课题项目(阜卫中(2014)号483-71)。

摘　　要：目的探讨狼疮性肾炎(LN)的临床病理特点并分析影响肾脏病理损害的相关危险因素。方法选取2013年1月至2018年10月本院收治的LN患者81例,对所有患者的资料进行回顾性分析,探讨LN的临床病理特点;并应用logistic回归模型分析影响肾脏病理损害的相关危险因素。结果81例LN患者的分布情况如下:Ⅰ型1例(1.2%);Ⅱ型9例(11.1%);Ⅲ/Ⅳ型14例(17.3%);Ⅴ型36例(44.4%);Ⅲ/Ⅳ+Ⅴ型20例(24.7%);Ⅲ+Ⅴ/Ⅳ+Ⅴ型1例(1.2%)。81例入组LN患者当中有58例(72.2%)LN患者在发病时以肾外临床表现起病,最常见的是血液系统损害、发热、关节痛及皮疹。不同病理分型的LN患者的临床表现类型各不相同,主要为肾病综合征、尿蛋白或(和)孤立性血尿,以Ⅱ型和Ⅲ/Ⅳ型LN患者占比最高。感染、低蛋白症及狼疮中度活动是影响LN患者发生肾脏病理损害的独立危险因素(P<0.05)。结论LN患者的临床表现各不相同,诊断时应结合患者的临床表现及生化指标,积极进行肾活检,避免漏诊、误诊而耽误治疗;治疗时要控制感染和营养支持,改善患者的肾功能。Objective To explore the clinical pathological features of lupus nephritis(LN)and analyze its related risk factors on renal pathological damage.Methods From January 2013 to October 2018,81 LN patients treated in our hospital were selected retrospectively.The COX regression model was used to analyze the risk factors affect renal pathological damage.Results The pathological type of 81 LN patients were:TypeⅠ1 case(1.2%),typeⅡ9 cases(11.1%),typeⅢ/Ⅳ14 cases(17.3%),typeⅤ36 cases(44.4%),typeⅢ/Ⅳ+Ⅴ20 cases(24.7%),typeⅢ+Ⅴ/Ⅳ+Ⅴ1 case(1.2%).Among 81 cases LN patients,58 patients(72.2%)developed the disease with extrarenal clinical manifestations,like blood system damage,fever,joint pain and skin rash.The clinical manifestations of LN patients with different pathological types were different,mainly nephrotic syndrome,urinary protein and/or isolated hematuria.The infection,hypoalbuminosis and lupus moderate activity were independent risk factors affected renal pathological damage in LN patients(P<0.05).Conclusions The clinical manifestations of LN patients are different.In the process of diagnosis,it is necessary to combine the clinical manifestations and biochemical indicators of patients,and conduct renal biopsy actively to avoid missed diagnosis and delaying the treatment.The infection control and nutritional support can improve renal function.

关 键 词：狼疮肾炎 感染 低蛋白血症 肾脏病理损害 

分 类 号：R593.242[医药卫生—内科学]