發(fā)布時(shí)間：2018-09-10 08:14

【摘要】：目的:比較系膜增生狼瘡性腎炎伴足細(xì)胞病與不伴足細(xì)胞病患者的臨床病理特征及預(yù)后差別。方法:108例腎活檢顯示腎小球系膜增生性狼瘡性腎炎患者[女99例,男9例,中位年齡30(21~39.3)歲],根據(jù)電鏡檢查足突融合和蛋白尿程度分為足細(xì)胞病組(足突融合范圍50%且伴腎病綜合征)和系膜增生組(足突融合≤50%)。系膜增生和腎小管間質(zhì)病變程度進(jìn)行半定量評分,系膜增生組根據(jù)有無蛋白尿分為血尿組(僅有鏡下血尿,無蛋白尿)和蛋白尿組(蛋白尿伴或不伴血尿)兩個(gè)亞組。比較不同組別臨床病理特征、治療反應(yīng)及預(yù)后的差異。結(jié)果:足細(xì)胞病組和系膜增生組分別有28例和80例,兩組足突融合比例分別為82.5%(70%,85%)和15%(10%,25%)。足細(xì)胞病組以腎病首發(fā)(60.7%vs 23.8%,P0.001)、腎病綜合征(100%vs1.25%,P0.001)、急性腎損傷(25.0%vs 2.5%,P=0.001)比例及腎小管間質(zhì)急性病變程度均顯著高于系膜增生組,而關(guān)節(jié)炎、發(fā)熱、低補(bǔ)體C4血癥(28.6%vs 52.5%,P=0.029)、抗磷脂抗體陽性及血尿發(fā)生率(21.4%vs42.5%,P=0.047)顯著低于系膜增生組。兩組系膜區(qū)免疫球蛋白和補(bǔ)體沉積、系膜增生程度無明顯差異,足細(xì)胞病組腎小管免疫球蛋白沉積率顯著高于系膜增生組(35.7%vs 2.5%,P0.001)。激素或激素聯(lián)合免疫抑制劑治療兩組緩解率無明顯差異,足細(xì)胞病組的腎臟復(fù)發(fā)率明顯高于系膜增生組(53.6%vs 29.0%,P=0.025)。在分別隨訪74個(gè)月(足細(xì)胞病組)和51個(gè)月(系膜增生組)期間,兩組均無死亡或進(jìn)展為ESRD。結(jié)論:有足細(xì)胞病的系膜增生性狼瘡性腎炎的臨床和形態(tài)學(xué)特征及轉(zhuǎn)歸與無足細(xì)胞病的系膜增生性狼瘡性腎炎存在顯著差異,兩者應(yīng)屬于不同類型的狼瘡性腎炎。
[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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