摘要
目的探讨狼疮肾炎患者肾组织血管病变与临床表现及预后的关系。方法总结1998年1月至2006年2月间，在北京协和医院接受B超引导下肾脏穿刺的系统性红斑狼疮（SLE）患者的肾脏病理及临床资料。根据肾脏血管病变性质，将患者分为无血管病变型（NVL）、免疫复合物沉积型（ICD）、狼疮血管病型（LV）、血栓性微血管病型（TMA）、血管炎型（VAS）和动脉硬化型（AS）6类。比较各型血管病变的病理特点、临床表现及预后。回顾性分析肾脏血管病变与患者临床表现及预后的关系。结果（1）451例病理资料中，247例（54．8％）存在不同类型的血管病变，其中AS型132例（29．3％），LV型44例（9．8％），ICD型38例（8．4％），TMA型30例（6．7％），VAS型3例（0．7％）。（2）Ⅳ型狼疮肾炎中血管病变的发生率高于其他各型，达69．7％。（3）除ICD型外，其他各型血管病变中高血压的发生率均高于无血管病变组（P〈0．05）；平均Scr水平也高于无血管病变组（P〈0．05），其中TMA型高血压发生率（76．7％）、平均Scr水平[（195．4±180．3）μmol／L]最高，与LV型、AS型间差异有统计学意义（P〈0．05）。TMA型贫血和血小板下降的发生率也高于其他各组。（4）TMA型的预后最差，2年肾脏生存率为50％，其他各组的预后差异无统计学意义。结论血管病变在狼疮肾炎患者中常见，其中TMA型病情重，预后差；除ICD型外，其他血管病变型也存在不同程度的血压和Scr水平的升高，但各组预后差异无统计学意义。
Objective To examine the relationship between renal vascular lesions and clinical prognosis in lupus nephritis patients. Methods Renal biopsy specimens and clinical data of 451 patients with lupus nephritis in our hospital from January 1998 to February 2006 were enrolled in this study. According to renal vascular lesions, those patients were classified into six groups： no renal vascular lesion （NVL）, immune complex deposits （ICD）, lupus vasculopathy （LV）, thrombotic microangiopathy （TMA）, vasculitis （VAS） and arteriosclerosis （AS）. The relationship of renal vascular lesions and the clinical features was retrospectively analyzed. Results （1） In 451 lupus nephritis patients, 247 cases （54.8%） had renal vascular lesion. The incidence of the ICD, LV, TMA, AS and VAS were 8.4%, 9.8%, 6.7%, 29.3% and 0.7%, respectively. （2） The incidence of vascular lesions in Ⅳ type lupus nephritis was 69.7%, which was higher than others. （3） Except ICD group, the incidences of renal insufficiency and hypertension were significantly higher in vascular lesion groups than those in NVL group （P〈0.05）. TMA group showed the most severe clinical manifestation, including anemia and depression of platelet. （4） The prognosis of TMA group was the worst. The prognosis among other groups was not significantly different. Conclusions Vascular lesions are common in lupus nephritis. TMA patients present not only the most severe clinical manifestation with the poorest prognosis. Other vascular lesions also indicate an elevation of blood pressure and Scr level, but without significant difference in prognosis.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2008年第7期449-455,共7页
Chinese Journal of Nephrology
