目的：探讨狼疮肾炎(lupus nephritis,LN)患者的临床表现、病理、免疫学特点及其相关因素。方法回顾性分析123例 LN患者临床、病理以及实验室资料,总结 LN 的临床病理、免疫学特征以及相关因素。观察内容及实验室检查指标：患者性别、年龄、临床肾脏损害及肾外损害的临床表现、肾活检病理类型,尿常规、24 h 尿蛋白定量、血常规、血肌酐、血清胱抑素 C(cystatin C,Cys C)、血白蛋白测定及血清免疫学检查。结果①123例 LN患者中女性106例(占86.38%),男性17例(占13.82%),发病年龄14~66岁,平均年龄(32.51±11.10)岁；②临床肾损害表现以肾炎综合征型(48例,占39.02%)和肾病综合征型(42例,占34.14%)多见,无症状型33例(占26.01%),肾功能不全型20例(占16.26%)；③LN病理为Ⅳ型者59例(占47.97%),Ⅱ型者44例(占35.77%),Ⅴ型者18例(占14.63%),Ⅲ型者2例(占1.63%)。其中男性以Ⅳ型、Ⅴ型为主(14例,占82.35%),Ⅱ型患者中女性42例,所占比例显著高于男性(39.6%比11.8%,P<0.05)；④单因素分析,脱发、口腔溃疡、浆膜腔炎、大量蛋白尿、贫血、白细胞减少、血小板减少、狼疮活动指数(systemic lupus erythe-matous disease activity index,SLEDAI)、血清 Cys C 升高分别在不同病理类型组间存在差异(P<0.05)；⑤以 LN病理、临床表现二分类进行 Logistic回归多因素分析,结果显示男性、贫血、大量蛋白尿、管型尿、血清Cys C升高者肾脏病理病变较重；⑥补体C3、C4降低者分别为80例(占65.04%)和51例(占41.46%),在病理Ⅳ型、Ⅴ型中尤为显著,Ⅳ型中C3降低者为44例(占74.57%),Ⅴ型中14例(占77.78%)；抗双股DNA抗体(Anti-double stranded DAN antibody,抗 dsDNA抗体)、抗核小体抗体(Anti-nucleosome antibody,AnuA)、抗组蛋白抗体(Anti-histone antibody,AHA)三种抗体均阳性的患者共33例,其病理类型无统计学差异(P>0.05),而 SLEDAI≥15分以上者30例(占90.91%)。结论①该组 LN患者以女性为主,临床表现肾炎综合征、肾病综合征为常见,病理类型Ⅳ型、Ⅱ型多见；②男性、大量蛋白尿、贫血,血清 Cys C 升高是 LN 患者肾脏病理病变较重的独立危险因素；③SLEDAI指数与临床多系统损害有相关性,与肾脏病理类型无相关性；④抗 ds-DNA抗体、AnuA、AHA是 SLE活动的指标,三种抗体联合测定对检测疾病活动性有重要意义。
目的：探討狼瘡腎炎(lupus nephritis,LN)患者的臨床錶現、病理、免疫學特點及其相關因素。方法迴顧性分析123例 LN患者臨床、病理以及實驗室資料,總結 LN 的臨床病理、免疫學特徵以及相關因素。觀察內容及實驗室檢查指標：患者性彆、年齡、臨床腎髒損害及腎外損害的臨床錶現、腎活檢病理類型,尿常規、24 h 尿蛋白定量、血常規、血肌酐、血清胱抑素 C(cystatin C,Cys C)、血白蛋白測定及血清免疫學檢查。結果①123例 LN患者中女性106例(佔86.38%),男性17例(佔13.82%),髮病年齡14~66歲,平均年齡(32.51±11.10)歲；②臨床腎損害錶現以腎炎綜閤徵型(48例,佔39.02%)和腎病綜閤徵型(42例,佔34.14%)多見,無癥狀型33例(佔26.01%),腎功能不全型20例(佔16.26%)；③LN病理為Ⅳ型者59例(佔47.97%),Ⅱ型者44例(佔35.77%),Ⅴ型者18例(佔14.63%),Ⅲ型者2例(佔1.63%)。其中男性以Ⅳ型、Ⅴ型為主(14例,佔82.35%),Ⅱ型患者中女性42例,所佔比例顯著高于男性(39.6%比11.8%,P<0.05)；④單因素分析,脫髮、口腔潰瘍、漿膜腔炎、大量蛋白尿、貧血、白細胞減少、血小闆減少、狼瘡活動指數(systemic lupus erythe-matous disease activity index,SLEDAI)、血清 Cys C 升高分彆在不同病理類型組間存在差異(P<0.05)；⑤以 LN病理、臨床錶現二分類進行 Logistic迴歸多因素分析,結果顯示男性、貧血、大量蛋白尿、管型尿、血清Cys C升高者腎髒病理病變較重；⑥補體C3、C4降低者分彆為80例(佔65.04%)和51例(佔41.46%),在病理Ⅳ型、Ⅴ型中尤為顯著,Ⅳ型中C3降低者為44例(佔74.57%),Ⅴ型中14例(佔77.78%)；抗雙股DNA抗體(Anti-double stranded DAN antibody,抗 dsDNA抗體)、抗覈小體抗體(Anti-nucleosome antibody,AnuA)、抗組蛋白抗體(Anti-histone antibody,AHA)三種抗體均暘性的患者共33例,其病理類型無統計學差異(P>0.05),而 SLEDAI≥15分以上者30例(佔90.91%)。結論①該組 LN患者以女性為主,臨床錶現腎炎綜閤徵、腎病綜閤徵為常見,病理類型Ⅳ型、Ⅱ型多見；②男性、大量蛋白尿、貧血,血清 Cys C 升高是 LN 患者腎髒病理病變較重的獨立危險因素；③SLEDAI指數與臨床多繫統損害有相關性,與腎髒病理類型無相關性；④抗 ds-DNA抗體、AnuA、AHA是 SLE活動的指標,三種抗體聯閤測定對檢測疾病活動性有重要意義。
목적：탐토랑창신염(lupus nephritis,LN)환자적림상표현、병리、면역학특점급기상관인소。방법회고성분석123례 LN환자림상、병리이급실험실자료,총결 LN 적림상병리、면역학특정이급상관인소。관찰내용급실험실검사지표：환자성별、년령、림상신장손해급신외손해적림상표현、신활검병리류형,뇨상규、24 h 뇨단백정량、혈상규、혈기항、혈청광억소 C(cystatin C,Cys C)、혈백단백측정급혈청면역학검사。결과①123례 LN환자중녀성106례(점86.38%),남성17례(점13.82%),발병년령14~66세,평균년령(32.51±11.10)세；②림상신손해표현이신염종합정형(48례,점39.02%)화신병종합정형(42례,점34.14%)다견,무증상형33례(점26.01%),신공능불전형20례(점16.26%)；③LN병리위Ⅳ형자59례(점47.97%),Ⅱ형자44례(점35.77%),Ⅴ형자18례(점14.63%),Ⅲ형자2례(점1.63%)。기중남성이Ⅳ형、Ⅴ형위주(14례,점82.35%),Ⅱ형환자중녀성42례,소점비례현저고우남성(39.6%비11.8%,P<0.05)；④단인소분석,탈발、구강궤양、장막강염、대량단백뇨、빈혈、백세포감소、혈소판감소、랑창활동지수(systemic lupus erythe-matous disease activity index,SLEDAI)、혈청 Cys C 승고분별재불동병리류형조간존재차이(P<0.05)；⑤이 LN병리、림상표현이분류진행 Logistic회귀다인소분석,결과현시남성、빈혈、대량단백뇨、관형뇨、혈청Cys C승고자신장병리병변교중；⑥보체C3、C4강저자분별위80례(점65.04%)화51례(점41.46%),재병리Ⅳ형、Ⅴ형중우위현저,Ⅳ형중C3강저자위44례(점74.57%),Ⅴ형중14례(점77.78%)；항쌍고DNA항체(Anti-double stranded DAN antibody,항 dsDNA항체)、항핵소체항체(Anti-nucleosome antibody,AnuA)、항조단백항체(Anti-histone antibody,AHA)삼충항체균양성적환자공33례,기병리류형무통계학차이(P>0.05),이 SLEDAI≥15분이상자30례(점90.91%)。결론①해조 LN환자이녀성위주,림상표현신염종합정、신병종합정위상견,병리류형Ⅳ형、Ⅱ형다견；②남성、대량단백뇨、빈혈,혈청 Cys C 승고시 LN 환자신장병리병변교중적독립위험인소；③SLEDAI지수여림상다계통손해유상관성,여신장병리류형무상관성；④항 ds-DNA항체、AnuA、AHA시 SLE활동적지표,삼충항체연합측정대검측질병활동성유중요의의。
Objective To analyze the clinical pathology and immunological features and related factors of Chinese patients with lupus nephritis (LN).Methods The clinical data,including age,sex, clinical renal and extrarenal damage,pathological category,and quantitation of urinary protein,blood routine,serum creatinine,cystatin C,serum albumin and immune indexes,including C3 and C4 comple-ments,antinuclear antibody (ANA),anti-double-stranded DNA antibody (AdsDNA),anti-smooth muscle antibody (Asm),anti-nucleosome antibody (AnuA),anti-histone antibody (AHA),were retro-spectively analyzed in 1 23 patients with LN.Results (1 ) Of 1 23 cases,there were 1 06 females (86.38%)and 17 males (13.82%)with age ranging from 14 to 60 years (mean 32.51 ±11.10 years);(2)Clinical renal damage occurred in 48 cases of nephritis syndrome type (39.02%),42 cases of nephrotic syndrome (34.14%),33 cases of asymptomatic type (26.01%),and 20 cases of renal in-sufficiency (16.26%);(3)The renal histological classes showed there were 59 cases of type Ⅳ(47.97%),44 cases of type Ⅱ (35.77%),18 cases of type Ⅴ (14.63%),and 2 cases of type Ⅲ(1.63%).The renal histological classes of male patients mainly showed there were 14 cases of type Ⅳand Ⅴ (82.35%).The proportion of type Ⅱ in females was higher than that in males (39.62%vs.11.76%,P<0.05);(4)Single factor analysis revealed there was significant difference in hair loss,buccal erythema,cavity inflammation,massive proteinuria,anemia,leukopenia,thrombocytopenia, systemic lupus erythematous disease activity index (SLEDAI),and cystatin C between the pathological type groups (P<0.05).(5)Logistic regression analysis of multiple factors between the LN pathologi-cal damage and clinical features indicated male,anemia,heavy proteinuria,cylindruria,high level of cys-tatin C in LN patients showed more seriously pathological damage.(6)C3 and C4 were significantly re-duced in the types Ⅳ (n=44,74.57%)and Ⅴ (n=14,77.78%)respectively.Those 33 cases positive for AdsDNA,AnuA and AHA showed no significant difference in the pathological types (P>0.05), and there were 30 cases (90.91%)with SLEDAI score ≥15.Conclusions (1)This group of LN pa-tients are still dominated by women,nephritic syndrome and nephrotic syndrome are commonly seen clinically,and types Ⅳ and Ⅱ are the mainly pathological damage.(2)There is certain relationship be-tween clinical features and pathological classifications in LN.Men,massive proteinuria,anemia,and el-evated cystatin C are the independent risk factors of the renal pathological lesions in patients with LN. (3)SLEDAI correlates with multiple system injury,but not with pathological types.(4)AdsDNA, AnuA and AHA are markers for disease activity,and combined detection of the 3 kinds of antibodies is crucial to test the disease activity of LN.
