狼疮肾炎合并抗中性粒细胞胞浆抗体阳性的临床分析

发布时间：2019-01-30 14:46

【摘要】：目的探讨狼疮肾炎(lupus nephritis,LN)合并抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)阳性患者的临床病理特征及预后。方法回顾性分析2011-2013年我院肾内科穿刺活检确诊的154例LN患者的临床表现及肾脏病理。采用欧蒙印迹法及间接免疫荧光法测定患者血清中的ANCA,分为ANCA阳性组和ANCA阴性组,比较两组患者流行病学、临床表现、实验室检查、肾脏病理、疾病活动度以及预后情况之间的差异。结果 ANCA阳性的LN患者26例(16.88%),其中MPO-ANCA 24例,PR3-ANCA 2例;ANCA阴性的LN患者128例。26例ANCA阳性的LN患者,脱发、口腔溃疡、光过敏及皮损的发生率明显高于ANCA阴性组(P值分别为0.007、0.016、0.022);抗核小体抗体及抗心磷脂抗体的发生率明显高于ANCA阴性组(P值分别为0.001、0.005);补体C3水平明显低于ANCA阴性组(P=0.034)。ANCA阳性组肾脏病理的肾小球球性硬化发生率及硬化比例、慢性指数(chronic index,CI)评分显著高于ANCA阴性组(P值分别为0.003、0.004、0.013),而病理类型分布、新月体形成、血管袢坏死、微血栓形成、肾小管萎缩及肾间质纤维化、活动指数(activity index,AI)评分、肾小管损伤(tubular interstitial lesion,TIL)评分、狼疮活动度(SLEDAI)评分两组间差异无统计学意义(P0.05)。ANCA阳性组尿蛋白转阴率明显低于ANCA阴性组(χ2=7.421,P=0.006),两组间死亡率差异无统计学意义(P0.05)。结论 ANCA阳性的LN患者易出现脱发、口腔溃疡、光过敏及皮损,肾脏病理可逆程度及预后较差,需早期积极治疗。
[Abstract]:Objective to investigate the clinicopathological features and prognosis of patients with lupus nephritis (lupus nephritis,LN) and antineutrophil cytoplasmic antibody (antineutrophil cytoplasmic antibodies,ANCA). Methods the clinical manifestations and renal pathology of 154 patients with LN confirmed by puncture biopsy in our hospital from 2011 to 2013 were analyzed retrospectively. ANCA, in serum of patients with positive ANCA and negative ANCA were divided into two groups, the epidemiology, clinical manifestation, laboratory examination and renal pathology. Differences in disease activity and prognosis. Results there were 26 cases (16.88%) of LN patients with ANCA positive, including 24 cases of MPO-ANCA and 2 cases of PR3-ANCA. The incidence of alopecia, oral ulcers, light hypersensitivity and skin lesions in 26 ANCA positive LN patients was significantly higher than that in ANCA negative LN patients (P = 0.007, 0.016, 0.022, respectively). The incidence of anti-nucleosome antibody and anticardiolipin antibody was significantly higher than that of ANCA negative group (P = 0.001 / 0.005). The level of complement C3 was significantly lower than that in ANCA negative group (P0. 034). ANCA positive group). The incidence of glomerular sclerosis and sclerosis ratio in renal pathology were significantly lower than those in ANCA negative group. (chronic index, was the chronic index. The CI score was significantly higher than that in ANCA negative group (P = 0.003, 0.004, 0.013, respectively), but the pathological types, crescents formation, vascular loop necrosis, microthrombus formation, tubular atrophy and interstitial fibrosis, activity index (activity index, There was no significant difference in AI score, (tubular interstitial lesion,TIL score of renal tubular injury and (SLEDAI) score of lupus activity between the two groups (P0.05) the negative rate of urinary protein in the positive). ANCA group was significantly lower than that in the ANCA negative group (蠂 2 + 7.421% P0. 006). There was no significant difference in mortality between the two groups (P0.05). Conclusion LN patients with positive ANCA are prone to alopecia, oral ulcers, light hypersensitivity and skin lesions, renal pathological reversible degree and poor prognosis, and need early active treatment.
【作者单位】：第三军医大学新桥医院肾内科;
【基金】：第三军医大学临床科研基金(2011XLC37)~~
【分类号】：R593.242

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