摘要
目的了解狼疮肾炎肾小管间质损伤的临床特点及其对预后的影响。方法收集1990年1月1日至2011年6月30日在解放军总医院肾脏病科经肾活检确诊为狼疮肾炎的309例患者的临床及病理资料,所有患者均符合1997年美国风湿病学会推荐的系统性红斑狼疮(SLE)分类标准。采用2003年国际肾脏病协会及肾脏病理学会修订的狼疮肾炎病理分型标准对所有患者进行重新病理分型。计算该组狼疮肾炎肾间质炎细胞浸润、肾小管萎缩、间质纤维化、肾小管上皮细胞变性的发生率;采用秩和检验分析不同类型狼疮肾炎之间肾小管间质损伤的差异及发生病理转型的Ⅳ型狼疮肾炎转型前后肾小管间质损伤的差异。采用Kaplan-Meier曲线分析肾小管间质损伤对狼疮肾炎预后的影响。结果 (1)本组狼疮肾炎病例中肾间质出现炎细胞浸润、肾小管萎缩、间质纤维化、肾小管上皮细胞变性的比例分别为86.5%,66.5%,66.9%和55.1%。(2)不同类型的狼疮肾炎其间质炎细胞浸润、肾小管萎缩、间质纤维化程及肾小管上皮细胞变性程度不同(均P﹤0.05);其中,Ⅲ型和Ⅳ型狼疮肾炎患者肾小管间质损伤较重(χ~2=13.857,P<0.001)。本组病例中有47例IV型狼疮肾炎患者行重复肾活检,其中有14例在第二次肾活检时转为Ⅱ型(29.7%),但其重复肾活检时间质炎细胞浸润、肾小管萎缩、间质纤维化及肾小管上皮细胞变性程度与转型前比较差异无统计学意义(均P>0.05)。(3)间质炎细胞浸润、肾小管萎缩及间质纤维化可影响患者的预后,病变越重,预后越差(均P﹤0.001);而各种程度的肾小管上皮细胞变性对患者预后无影响(P=0.07)。结论狼疮肾炎肾小管间质损伤发生率高,不同类型的狼疮肾炎的肾小管间质病变程度不同。肾小管间质损伤程度不影响IV型狼疮肾炎的病理转型,且病理转型前后肾小管间质损害改变不明显。肾小管间质损伤可�
Objective To investigate the clinical characteristics of tubulointerstitial lesions （TIL） and their impacts on prognosis of lupus nephritis. Methods Three hundred and nine patients with lupus nephrits from the Department of Nephrology, Chinese PLA General Hospital, were confirmed by renal biopsy. Clinical and pathological parameters of this cohort were collected. All patients were reviewed and reclassified according to the 2003 Classification System of International Society of Nephrology （ISN）/Renal Pathology- SocieU （RPS）. Semiquantitative score was used to assess the severiU of renal injury-. Kaplan- Meier curve was used to analyze the outcomes of patients with different TIL. Results The percentages of interstitial ilfflammatory- cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration were 86.5% ,66.5% ,66.9% , and 55.1% , respectively. Class Ⅱ, Ⅲ, Ⅳ, and V lupus nephritis were different from each other in the interstitial ilfflammatory- cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration （ all P 〈 0.05 ）. The severity- of TIL in class Ⅲ and 1V lupus nephritis were more severe than those in class Ⅱ and V （X2 =13. 857, P 〈 0. 001 ）. 47 patients with class 1V lupus nephritis received repeat-biopsies, among whom 14 eases transformed to class Ⅱ , but the differences in interstitial ilLflanmlatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration were not significant （ all P 〉 0.05 ）. The interstitial ilLflanmlatory cells infiltration, tubular atrophy, and interstitial fibrosis were associated with the patients＇ prognosis： the more severe TILs, the poorer prognosis （all P 〈 0.001 ）. Conclusions The incidence of TILs in lupus nephritis was high. TILs in different classes of lupus nephritis were different from each other. The degree of TILs did not affect the pathological transformation of class IV lupus nephritis, and the c
作者
张岩
蔡广研
刘述文
张雪光
寇佳
陈仆
吴杰
孟金铃
尹忠
张利
陈香美
Zhang Yan;Cai Guangyan;Liu Shuwen;Zhang Xueguang;Kou Jia;Chen Pu;Wu Jie;Meng Jinling;Yin Zhong;Zhang Li;Chen Xiangmei(Department of Nephrology,Chinese PLA General Hospital,Chinese PLA Institute of Nephrology,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beifing 100853,China Corresponding author ： Cai Guangyan,Email ： caiguangyan@ sina.com)
出处
《中华肾病研究电子杂志》
2017年第2期58-63,共6页
Chinese Journal of Kidney Disease Investigation（Electronic Edition）
关键词
狼疮肾炎
肾小管间质损伤
预后
Lupus nephritis
Tubulointerstitial lesions
Prognosis
