肾损害首发的系统性红斑狼疮患者临床特点及病理资料分析

发布时间：2018-05-27 20:28

  本文选题：系统性红斑狼疮 + 狼疮性肾炎　； 参考：《吉林大学》2015年硕士论文

【摘要】：目的：本研究通过对肾损害首发的系统性红斑狼疮患者的病历资料进行回顾性分析，与皮肤损害首发、关节肌肉损害首发、血液系统损害首发、发热首发等非肾损害首发的SLE患者进行对比，总结SLE患者中肾损害首发者的临床表现、伴随症状、一般实验室检查、病理特点，探讨狼疮性肾炎的早期诊断。 方法：回顾性分析2009年1月至2014年12月间于吉林大学第二医院就诊明确诊断为SLE并住院治疗的437例患者，以肾损害首发的143例为研究对象，非肾损害首发的294例包括皮肤损害首发的115例、关节肌肉损害首发的63例、血液系统损害首发42例、发热首发52例、心脏损害首发7例、呼吸系统损害首发6例、神经系统损害首发6例、消化系统损害首发3例作为对照，详细记录性别、年龄、病情活动度评分、伴随的临床症状、实验室指标包括常规实验室检查和免疫学检查，以及肾脏损害首发者81例和非肾脏损害首发者94例共175例行肾穿刺术患者的肾穿病理资料，应用统计学方法分析后得出相应结果。 结果：1）SLE患者发病有明显的性别倾向，男女比例为1:8.71，男性年龄13~84岁（39.01±17.091），，女性年龄7~80岁（38.08±14.23）；2）SLEDAI评分评价患者病情活动度，肾损害首发组以病情重度活动为主，以基本无活动的比例最小；3）肾损害首发组患者较易合并血液系统损害、关节肌肉损害、脱发、皮肤损害等，明确SLE或LN诊断前主要诊断为肾病综合征、慢性肾炎、蛋白尿、慢性肾功能衰竭、急性肾损害等，多就诊于肾风湿科；4）肾损害首发组肾脏损害相关的实验室指标异常的阳性率均高于非肾损害首发组；5）免疫学指标肾损害首发组IgG和CRP升高的比例小于非肾损害首发组，C4降低的比例大于非肾损害首发组，有统计学差异。6）肾损害非首发组抗dsDNA抗体阳性率（76.44%）明显高于肾损害首发组（62.43%）和肾脏未受累组（37.70%），P分别为0.009和0＜0.01，有统计学显著差异。在SLE肾脏受累的患者中抗dsDNA阳性率比AnuA高，P=0＜0.01，两检测方法差异有统计学意义。AnuA、抗U1RNP抗体、抗Sm抗体、抗SSB抗体、抗组蛋白抗体阳性率、Anti-P阳性率在各组间无显著差异。7）肾损害首发组与非肾损害首发组病理类型以Ⅳ型和Ⅳ+Ⅴ型为主，肾损害首发组Ⅳ型比例高于非肾损害首发组，Ⅱ型LN的比例低于非肾损害首发组，有统计学差异。8）Ⅲ型LN患者主要表现为慢性肾炎，Ⅳ型、Ⅴ型、Ⅲ+Ⅴ型及Ⅳ+Ⅴ型主要表现为肾病综合征。9）肾损害首发组各病理类型均易合并血液系统损害。 结论：1）SLE患者常见肾损害，且常常是首发表现；2）在SLE患者中，抗dsDNA抗体具有肾脏损害特异性，且比ANuA更敏感；3）两组LN患者肾活检病理类型以Ⅳ型为主，其次是Ⅳ+Ⅴ型；4）肾损害临床表现不同的SLE患者均可出现典型的肾脏病理学改变。
[Abstract]:Objective: through retrospective analysis of the medical records of patients with systemic lupus erythematosus (SLE) with renal damage, the first episode was with skin damage, joint and muscle damage, and blood system damage. In order to explore the early diagnosis of lupus nephritis, the clinical manifestations, associated symptoms, general laboratory examination and pathological features of the patients with SLE were summarized. Methods: from January 2009 to December 2014, 437 patients who were diagnosed as SLE and hospitalized at the second Hospital of Jilin University were retrospectively analyzed. 294 cases of non-renal lesion included 115 cases of skin damage, 63 cases of joint and muscle damage, 42 cases of blood system damage, 52 cases of fever, 7 cases of heart damage and 6 cases of respiratory system damage. The first 6 cases of nervous system damage and 3 cases of digestive system damage were used as control. Gender, age, disease activity score, clinical symptoms, laboratory indexes including routine laboratory examination and immunological examination were recorded in detail. Renal biopsy data of 175 cases of renal puncture in 81 cases of renal injury and 94 cases of non-renal lesion were analyzed by statistical method. Results there was a significant sexual tendency in the onset of SLE in the male and female patients, the male / female ratio was 1: 8.71, the male age was 139.01 卤17.091g, the female age was 78.08 卤14.232SLEDAI, and the severity of the disease was the main activity in the first group of renal damage. Patients in the initial group of renal damage were more likely to be complicated with hematological damage, joint muscle damage, alopecia, skin damage and so on. It was clear that SLE or LN were mainly diagnosed as nephrotic syndrome, chronic nephritis, proteinuria before diagnosis. Chronic renal failure, acute renal damage, etc. The positive rate of abnormal laboratory indexes related to renal damage in the first renal lesion group was higher than that in the non-renal lesion initial group (5) the proportion of IgG and CRP increased in the first renal lesion group was lower than that in the non-renal lesion first group. The rate of decrease of C _ 4 in hair group was higher than that in non-renal lesion group. The positive rate of anti-dsDNA antibody in the non-initial group of renal damage was significantly higher than that in the first group of renal damage (62.43) and the unaffected group was 37. 70% (P < 0. 01), which was significantly higher than that in the non-initial group of renal damage (P < 0. 01). The positive rate of anti dsDNA in patients with renal involvement of SLE was higher than that of AnuA. The difference between the two methods was statistically significant. Anua, anti U1RNP antibody, anti Sm antibody, anti SSB antibody, The positive rate of anti-histone antibody and Anti-P positive rate were not significantly different among the groups. 7) the pathological types of renal lesion first group and non-renal lesion initial group were mainly type 鈪

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