狼疮肾炎的病理和免疫学指标及临床相关性分析

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?

Clinical pathology and immunological features in patients with LN and related factors

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,