伴抗磷脂综合征狼疮性肾炎患者的临床特点及预后

发布时间：2019-04-15 18:00

【摘要】：目的:探讨伴抗磷脂综合征(APS)狼疮性肾炎(LN)患者的临床病理特点及肾脏远期预后。方法:回顾性分析2002年至2014年期间在南京军区南京总医院肾脏科经肾活检确诊为LN且符合APS分类标准的汉族患者,并与同期不伴APS的LN患者比较,分析其临床表现、肾组织病理特点及肾脏远期预后差异。结果:共收集53例合并APS的LN患者,随机选择106例不伴APS的LN患者,发现APS组患者在狼疮活动、血栓发生、心脏受累及抗凝药物的应用上明显高于对照组(P0.05);而在LN病程、高血压、蛋白尿、血尿、血清白蛋白(Alh)、血清肌酐(SCr)、血红蛋白(Hb)、自细胞(WBC)、血小板(PLT)减少、自身抗体、补体水平及诱导方案的选择和治疗反应方面无明显差异。APS组患者血栓性微血管病所占比例更高。随访63.7个月两组肾脏存活率未见统计学差异。结论:伴APS的LN患者疾病活动性更强、血栓事件和心脏受累更为常见,抗凝应用更为积极,但肾脏预后与不伴APS的患者未见明显统计学差异。
[Abstract]:Objective: to investigate the clinicopathological features and renal long-term prognosis of (LN) patients with antiphospholipid syndrome (APS) lupus nephritis. Methods: the patients of Han nationality who were diagnosed as LN by renal biopsy in Nanjing General Hospital of Nanjing military region from 2002 to 2014 in accordance with APS classification criteria were retrospectively analyzed, and the clinical manifestations were compared with those of LN patients without APS in the same period. The pathological features of renal tissue and the long-term prognosis of kidney were different. Results: a total of 53 LN patients with APS were collected, and 106 LN patients without APS were randomly selected. It was found that the lupus activity, thrombosis, cardiac involvement and the use of anticoagulant in APS group were significantly higher than those in control group (P0.05). In the course of LN, hypertension, proteinuria, serum albumin (Alh), serum creatinine, (SCr), hemoglobin, (Hb), autologous (WBC), platelet (PLT) decreased, autoantibodies, There was no significant difference in complement level, selection of induction scheme and response to treatment. The percentage of thrombotic microangiopathy in APS group was higher than that in control group. There was no significant difference in renal survival rate between the two groups after 63.7 months of follow-up. Conclusion: the disease activity of LN patients with APS is stronger, thrombus events and heart involvement are more common, and anticoagulant use is more active. However, there is no significant difference in renal prognosis between patients with APS and those without APS.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家重点研发计划课题(2016YFC0904103) 国家科技支撑计划课题(2015BAI12B02,2015BAI12B05)
【分类号】：R593.242

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