狼疮性肾炎足细胞病伴系膜增生患者的临床病理特点

发布时间：2018-09-10 08:14

【摘要】：目的:比较系膜增生狼疮性肾炎伴足细胞病与不伴足细胞病患者的临床病理特征及预后差别。方法:108例肾活检显示肾小球系膜增生性狼疮性肾炎患者[女99例,男9例,中位年龄30(21~39.3)岁],根据电镜检查足突融合和蛋白尿程度分为足细胞病组(足突融合范围50%且伴肾病综合征)和系膜增生组(足突融合≤50%)。系膜增生和肾小管间质病变程度进行半定量评分,系膜增生组根据有无蛋白尿分为血尿组(仅有镜下血尿,无蛋白尿)和蛋白尿组(蛋白尿伴或不伴血尿)两个亚组。比较不同组别临床病理特征、治疗反应及预后的差异。结果:足细胞病组和系膜增生组分别有28例和80例,两组足突融合比例分别为82.5%(70%,85%)和15%(10%,25%)。足细胞病组以肾病首发(60.7%vs 23.8%,P0.001)、肾病综合征(100%vs1.25%,P0.001)、急性肾损伤(25.0%vs 2.5%,P=0.001)比例及肾小管间质急性病变程度均显著高于系膜增生组,而关节炎、发热、低补体C4血症(28.6%vs 52.5%,P=0.029)、抗磷脂抗体阳性及血尿发生率(21.4%vs42.5%,P=0.047)显著低于系膜增生组。两组系膜区免疫球蛋白和补体沉积、系膜增生程度无明显差异,足细胞病组肾小管免疫球蛋白沉积率显著高于系膜增生组(35.7%vs 2.5%,P0.001)。激素或激素联合免疫抑制剂治疗两组缓解率无明显差异,足细胞病组的肾脏复发率明显高于系膜增生组(53.6%vs 29.0%,P=0.025)。在分别随访74个月(足细胞病组)和51个月(系膜增生组)期间,两组均无死亡或进展为ESRD。结论:有足细胞病的系膜增生性狼疮性肾炎的临床和形态学特征及转归与无足细胞病的系膜增生性狼疮性肾炎存在显著差异,两者应属于不同类型的狼疮性肾炎。
[Abstract]:Objective: to compare the clinicopathological features and prognosis of Mesangial proliferative lupus nephritis with and without podocytosis. Methods one hundred and eight patients with glomerular Mesangial proliferative lupus nephritis [99 female, 9 male, 9 male] were examined by renal biopsy. The median age was 30 years (21 / 39.3). According to the degree of foot process fusion and proteinuria, the patients were divided into podocyte disease group (50% foot process fusion range and nephrotic syndrome) and Mesangial hyperplasia group (foot process fusion 鈮，

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