抗中性粒细胞胞质抗体阳性狼疮肾炎的临床病理特征分析  

Clinicopathologic characteristics of lupus nephritis with positive antineutrophil cytoplasmic antibody

作　　者：赵思媛 文景平 王欣[1] 文琼[1] 李志坚[1] 陈崴[1] 陈雄辉[1] Zhao Siyuan;Wen Jingping;Wang Xin;Wen Qiong;Li Zhijian;Chen Wei;Chen Xionghui(Department of Nephrology,the First Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Nephrology,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科,国家卫健委及广东省肾脏病重点实验室,广州510080

出　　处：《中华肾脏病杂志》2022年第11期961-968,共8页Chinese Journal of Nephrology

摘　　要：目的探讨抗中性粒细胞胞质抗体(antineutrophil cytoplasmic antibody,ANCA)阳性狼疮肾炎(lupus nephritis,LN)患者的临床病理学特征,为认识及诊治该类疾病提供更多临床数据。方法回顾性收集和分析2002年11月1日至2020年9月11日在中山大学附属第一医院住院并经肾活检确诊为LN患者的临床资料,从中筛选出有ANCA检测结果患者的资料,比较ANCA阳性组与ANCA阴性组患者临床资料、实验室检查及肾脏病理检查的差异。比较ANCA不同血清型间临床病理特征的差异。结果纳入经肾活检证实为LN且有ANCA检测结果患者1304例,年龄14~76岁,男性240例,女性1064例,其中ANCA阳性LN患者80例(6.1%)。ANCA阳性LN患者中,55例(68.8%)为MPO-ANCA,14例(17.5%)为PR3-ANCA阳性,11例(13.8%)为MPO-ANCA和PR3-ANCA双阳性。与ANCA阴性LN患者(分层抽样160例)比较,ANCA阳性LN患者血清肌酐[135.5(68.0,361.8)μmol/L比88.0(64.0,165.0)μmol/L,P=0.004]、血尿素氮[12.35(6.35,21.18)mmol/L比8.60(5.50,15.70)mmol/L,P=0.026]明显较高,估算肾小球滤过率[45.70(13.83,84.10)ml·min^(-1)·(1.73 m^(2))^(-1)比66.75(38.43,96.22)ml·min^(-1)·(1.73 m^(2))^(-1),P=0.001]明显较低。ANCA阳性LN患者的慢性指数高于ANCA阴性LN患者[3(2,7)比2(0,5),P=0.006]。MPO-ANCA阳性组、PR3-ANCA阳性组及MPO-ANCA和PR3-ANCA双阳性组之间血红蛋白、血清肌酐和估算肾小球滤过率的差异均有统计学意义(均P<0.05),其中MPO-ANCA和PR3-ANCA双阳性LN患者血红蛋白和估算肾小球滤过率最低,血清肌酐最高(均P<0.05)。结论相比ANCA阴性LN患者,ANCA阳性LN患者肾功能较差,肾组织病理学慢性指数较高,尤其是MPO-ANCA及PR3-ANCA双阳性患者,这一亚群LN患者可能需要更严格的监测和治疗。Objective To explore the clinical and histopathologic features of lupus nephritis(LN)patients with positive antineutrophil cytoplasmic antibody(ANCA),so as to provide more theoretical basis to recognize and treat this disease.Methods Clinical data of biopsy-proven LN patients with ANCA test in the First Affiliated Hospital of Sun Yat-sen University from November 1,2002 to September 11,2020 were collected and analyzed retrospectively.The difference of clinical data,laboratory examination,and pathological examination of renal biopsy between ANCA-positive group and ANCA-negative group.The clinicopathological characteristics between different ANCA serotypes were compared.Results A total of 1304 patients with LN confirmed by renal biopsy and ANCA test results were enrolled.Eighty ANCA-positive patients from 1304 LN patients were screened.There are 55(68.8%)ANCA-positive LN patients with positive anti-myeloperoxidase antibodies(MPO).There were 14(17.5%)ANCA-positive LN patients with positive anti-proteinase 3 antibodies(PR3),and 11(13.8%)ANCA-positive patients with double positive antibodies of MPO and PR3.ANCA-positive LN patients had significantly higher serum creatinine[135.5(68.0,361.8)μmol/L vs 88.0(64.0,165.0)μmol/L,P=0.004]and blood urea nitrogen[12.35(6.35,21.18)mmol/L vs 8.60(5.50,15.70)mmol/L,P=0.026]as well as lower estimated glomerular filtration rate[45.70(13.83,84.10)ml·min^(-1)·(1.73 m^(2))^(-1) vs 66.75(38.43,96.22)ml·min^(-1)·(1.73 m^(2))^(-1),P=0.001]than ANCA-negative patients(stratified sampling of 160 patients).ANCA-positive LN patients had higher chronicity index than ANCA-negative LN patients[3(2,7)vs 2(0,5),P=0.006].There were statistically significant difference in hemoglobin,serum creatinine and estimated glomerular filtration rate among ANCA-positive group,ANCA-negative group,and MPO-ANCA and PR3-ANCA double positive group.MPO-ANCA and PR3-ANCA double positive LN patients had the lowest hemoglobin and estimated glomerular filtration rate,and highest serum creatinine among the three grou

关 键 词：抗体 抗中性白细胞胞质 狼疮肾炎 病理学 临床 

分 类 号：R593.242[医药卫生—内科学]