CAJ | 학술논문

目的评估肾小球微血栓(GMT)在狼疮肾炎(LN)中的发生率,并探讨针对某些凝血相关因子的抗体和抗磷脂抗体在LN患者GMT形成中的临床意义.方法连续收集124例LN患者肾活检组织标本和血浆,观察组织标本中GMT的发生率.并分成LN-GMT组和LN-non-GMT组;比较两组患者的疾病活动度、相关实验室检查指标和肾组织活动,慢性指数;测定患者的狼疮抗凝物(LA)、抗心磷脂抗体(ACL)、抗β2糖蛋白I(抗β2GP I)抗体、抗凝血酶抗体、抗纤溶酶抗体、抗组织型纤溶酶原激活物(t-PA)抗体和抗膜联蛋白AⅡ(Annexin A II)抗体.结果 GMT在LN中的发生率约为20.2%;LN-GMT组系统性红斑狼疮疾病活动指数(SLEDAI)、肾组织病变活动指数、肾组织病变慢性指数、尿蛋白定量(24 h)、血清肌酐、血清尿素氮的水平和高血压的发生率都较LN-non-GMT组高(P＜0.01);LN-GMT组LA、IgG型抗B2GP I抗体和抗凝血酶抗体阳性率均显著高于LN-non-GMT组(P＜0.05);两组IgG型ACL抗体、抗纤溶酶抗体、抗t-PA抗体和抗Annexin A II抗体阳性率差异均无统计学意义(P＞0.05);两组各抗体IgM型差异无统计学意义(P＞0.05).结论 LN中伴有GMT形成的患者肾脏病变重于无GMT者;LA、IgG型抗β2GP I抗体和抗凝血酶抗体与LN患者GMT形成相关.
목적 평고신소구미혈전(GMT)재랑창신염(LN)중적발생솔,병탐토침대모사응혈상관인자적항체화항린지항체재LN환자GMT형성중적림상의의.방법 련속수집124례LN환자신활검조직표본화혈장,관찰조직표본중GMT적발생솔.병분성LN-GMT조화LN-non-GMT조;비교량조환자적질병활동도、상관실험실검사지표화신조직활동,만성지수;측정환자적랑창항응물(LA)、항심린지항체(ACL)、항β2당단백I(항β2GP I)항체、항응혈매항체、항섬용매항체、항조직형섬용매원격활물(t-PA)항체화항막련단백AⅡ(Annexin A II)항체.결과 GMT재LN중적발생솔약위20.2%;LN-GMT조계통성홍반랑창질병활동지수(SLEDAI)、신조직병변활동지수、신조직병변만성지수、뇨단백정량(24 h)、혈청기항、혈청뇨소담적수평화고혈압적발생솔도교LN-non-GMT조고(P＜0.01);LN-GMT조LA、IgG형항B2GP I항체화항응혈매항체양성솔균현저고우LN-non-GMT조(P＜0.05);량조IgG형ACL항체、항섬용매항체、항t-PA항체화항Annexin A II항체양성솔차이균무통계학의의(P＞0.05);량조각항체IgM형차이무통계학의의(P＞0.05).결론 LN중반유GMT형성적환자신장병변중우무GMT자;LA、IgG형항β2GP I항체화항응혈매항체여LN환자GMT형성상관.
Objective To investigate the prevalence of glomerular microthrombosis in lupus nephritis (LN) and the significance of antibodies to anti-coagulation related factors and anti-phospholipid antibodies in glomerular microthrombosis (GMT).Methods Kidney biopsy specimens and plasma samples were obtained consecutively from 124 patients with LN. Kidney biopsy specimens were examined for the presence of glomerular microthrombi.Plasma samples from 25 LN patients with GMT (LN-GMT group) and 99 LN patients without GMT (LN-non-GMT group) were tested for lupus anticoagnlant (LA) and antibodies to cardiolipin (ACL),β2 glycoprotein I (β2GP I ),plasmin,thrombin,tissue plasminogen activator (t-PA) and Annexin A II.Results The prevalence of GMT in LN patients was about 20.2%.Compared to LN-non-GMT group,LN-GMT group had elevated SLE disease activity indices (SLEDAI),elevated activity and chronicity indices of kidney tissue injury,and elevated serum creatinine,blood urea nitrogen and proteinuria levels,and also had a higher frequency of hypertension (P＜0.01).The positive rates of LA,IgG class anti-β2GP I and anti-thrombin antibodies were higher in LN-GMT group than in LN-non-GMT group (P＜0.05).The positive rates of IgG class antibodies to ACL,plasmin,t-PA and Annexin A II in LN-GMT group were not statistically different from those in LN-non-GMT group (P＞0.05).No difference was found in the positive rate of any IgM class antibody between the two groups (P＞0.05).Conclusion This study has shown that GMT occurs approximately in 20.2% of the LN patients.Patients with GMT have more severe kidney tissue injury and more poor renal outcomes than patients without GMT.LA and antibodies to β2GP I and thrombin play a role in glomerular microthrombosis in lupus nephritis.