狼疮肾炎60例临床与病理分析.docVIP

狼疮肾炎60例临床与病理分析 　　作者：金明，张 虹 作者单位：435332 湖北蕲春，蕲春县第二人民医院 　　【摘要】 目的 探讨狼疮性肾炎病理类型与临床的关系，进而为临床病情的评估及治疗提供参考。方法 回顾性分析于2002mdash;2009年就诊的60例狼疮肾炎患者临床表现与病理类型及相关实验室检测结果，病理分型按 WHO1995年分型标准进行,分别进行活动性指数(AI)、慢性指数(CI)和肾小管间质病变(TIL)评分，同时分析LN病理活动指数与临床活动指数的相关性。结果 病理类型以Ⅳ型LN最多，占41.67%，其次是Ⅱ型33.33%，Ⅴ型和Ⅲ型较少，分别占13.33%和11.67%。Ⅱ型与Ⅲ型多表现为肾炎综合征，Ⅳ型和Ⅴ型多表现为肾病综合征。蛋白尿以Ⅳ型和Ⅴ型为重，跟Ⅱ型比较差异有显著性，Ⅳ型LN的血尿、肾功能不全发生率、抗ds-DNA抗体阳性率最高，其AI亦显著高于其他类型, TIL评分和CI也较Ⅱ型明显高。临床活动指数与病理活动性指数呈正相关。结论 LN的病理改变与临床表现有一定的关系，根据其临床表现和实验室检查结果可大致推测其病理类型。 　　【关键词】 狼疮性肾炎;肾活检;病理分型;临床表现 　　Clinical and pathological analysis of 60 cases with lupus nephritis 　　JIN Ming,ZHANG Hong. Qichun Second Peoples Hospital,Qichun 435332,China 　　[Abstract] Objective To investigate lupus nephritis(LN) combined with renal biopsy and relevant laboratory parameters，and provide reference for assessing clinical patients condition and therapy.Methods 60 patients with LN admitted during 2002mdash;2009 in hospital were collected and their data of renal biopsy and routine laboratory tests were recorded.Pathological classification was based on the standard criteria of WHO1995，and scored their active index(AI),chronic index(CI),tubular interstitial lesion(TIL).Then we analyzed correlation between clinical activity index and pathological activity index. Results Type Ⅳ was most common(41.67%)，type II(33.33%) was next，type Ⅴ (13.33%) and Ⅲ(11.67%) were fewer.Type II and Ⅲ usually manifested as nephritis syndrome，while type Ⅳ and Ⅴ mainly as nephritic syndrome.Urine protein in patients with Type Ⅳ and Ⅴ LN were higher than in patients with Type II LN.Type Ⅳ was the most active one with a prevalence of hematuria，renal insufficiency and anti-ds-DNA antibody. AI in type Ⅳ was significantly higher than others .CI and TIL scoring in type Ⅳ was also higher than in type II.There was a positive correlation between LN clinical activity index and pathological activity index.Conclusions There is relation between pathological change and clinical manifestations o