摘要
目的 :根据肾脏血管病变的特点 ,建立弥漫增殖型狼疮性肾炎的病理分型 ,评价其对判断病情、指导治疗及评价预后的意义。 方法 :根据肾活检病理肾小球毛细血管及间质血管病变特点将 341例弥漫增殖型狼疮性肾炎分为 4组 :弥漫增殖组 (A组 12 8例 )、袢坏死组 (B组 86例 )、袢坏死伴间质血管病变组 (C组 4 8例 )、血栓形成组 (D组 79例 ) ;回顾性分析各组患者临床表现、对不同免疫抑制治疗的近期疗效及长期预后。 结果 :1四组患者构成比分别为 37.54%、2 5.2 1%、14.0 8%和 2 3.17%。2临床表现 A组最轻 ,D组最重 ,反映在尿蛋白、尿红细胞、血清肌酐水平及肉眼血尿、肾功能不全的比例上 ;肾外系统性病变 :D组患者合并高血压 (6 4 .94 % )、心脏病变 (32 .93% )及贫血者较 A组多见 ,C组更多地合并中枢神经病变 (19.15% ) ,B组的平均血色素水平在各组中最低 ,而皮肤关节病变却在 A组最常见。 3尽管免疫球蛋白 (Ig G)水平及 ANA、抗Sm抗体等阳性率无组间差异 ,但 D组患者抗 ds- DNA阳性率显著高于其它三组 ,此外合并 MPO-ANCA和抗心磷脂抗体阳性者也主要见于 C、D组 ;补体下降以 D组最显著 ,A组居次。 4在治疗上 ,弥漫增殖 (A)组对激素和 CTX治疗均有较好疗效 ,有效率分别达 84 .6 1%和 89.93% ;D组只有
OBJECTIVE To investigate the signifieance of glomerular and interstitial vascular injury on treatment response and the progression of diffuse proliferative lupus nephritis. METHODOLOGY Retrospectively,341 patients with biopsy proven diffuse proliferative lupus nephritis were divided into four subtypes based on the following glomerular and interstitial lesinos:The diffuse cellular proliferative group(subtype A, n =128);capillary necrosis group(subtype B, n =86);capillary necrosis with interstitial vasculopathy group(subtype,C, n =48);and thrombosis group(subtype D, n =79).The clinical features,the different in the response to steroid and/or cyclophosphamide therapy and in long term outcome among these groups of patients were analyzed. RESULT ①The percentage of the four subtypes(A,B,C,D) were 37 54%,25 23%,14 08% and 23 17% respectively in this study.Age,the age of onset and clinical course were matched among the four subgroups of patients.However,the prevalence of subtype D lupus nephritis was higher in male(34 78%)than in female(23 61%).While the prevalence of subtype A was less common in male than in female (23 91% vs 39 66%, P <0 55).②of all subtypes,renal lesions were the mildest in subtype A,and the most severe in subtype D as judged by the active and chronic index.Patients in subtype C and D had heavier proteinuria and hematuria than those in subtype A.45 45% patients of subtype D had renal insufficency (Scr>132 6μmol/L)at the time of biopsy.③Hypertension,cardiac abnormality and anemia were more frequent in subtype D than in subtype A.It was noted that central nervous disorder was common in patients with subtype C lupus nephritis,while anemia was the most common in subtype B.④Although the mean serum levels of IgG,ANA and anti smith antibidi
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
1998年第3期235-242,共8页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
弥漫增殖型
狼疮性肾炎
血管病变
病理
diffuse proliferative lupus nephritis subtypes vascular lesions
