临床特点联合实验室指标对狼疮肾炎病理分型的预测研究

王芬; 徐建华; 蔡静玉; 汤华阳; 吴永贵; 卢文

doi:10.16462/j.cnki.zhjbkz.2016.07.020

临床特点联合实验室指标对狼疮肾炎病理分型的预测研究

doi: 10.16462/j.cnki.zhjbkz.2016.07.020

1. 安徽医科大学第一附属医院风湿免疫科, 安徽合肥 230022;
2. 安徽医科大学第一附属医院皮肤科, 安徽合肥 230022;
3. 安徽医科大学第一附属医院检肾内科, 安徽合肥 230022

基金项目:

国家自然科学基金（81371722）

详细信息

作者简介:
王芬(1964-),女,广西北海人,副主任医师,学士。主要研究方向:风湿免疫病,系统性红斑狼疮。

中图分类号: R593.241
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出版历程
- 收稿日期: 2016-01-11
- 修回日期: 2016-04-27

Clinical and laboratory predictors of pathological classification of lupus nephritis

1. Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;
2. Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;
3. Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

摘要

摘要: 目的通过临床及实验室指标，建立狼疮肾病理分型的预测模式。方法 2011-2015年我院住院有肾病理的系统性红斑狼疮（systemic lupus erythematosus,SLE）患者，经糖皮质激素等治疗2月以上，尿蛋白仍阳性的患者201例，分析其临床及实验室指标，采用Epi Data 3.1 和SPSS 21.0软件进行统计。结果 Ⅱ型17例，Ⅲ型26例，Ⅳ型135例，Ⅴ型23例；单因素分析：增殖型年龄及发病年龄均小、SLEDAI高、贫血多、C3低、C1q（64.0%）及ds-DNA阳性率均高（53.4%）；膜型发病年龄大，ds-DNA阳性率低（13.0%）；系膜型卧位后尿蛋白转阴性率为67.4%。Logistic回归分析显示,相对于其它类型，系膜型SLEDAI低，卧位后尿蛋白转阴性率高；增殖型SLEDAI高、尿蛋白阳性率及抗 ds-DNA 阳性率均高；膜型发病年龄大、抗 ds-DNA阳性率低。结论狼疮肾病理分型的预测模式：SLEDAI低，卧位后尿蛋白转阴性率高是Ⅱ型的强预测指标；SLEDAI高、尿蛋白阳性、抗 ds-DNA 阳性，是Ⅲ/Ⅳ型的预测指标；发病年龄大、抗 ds-DNA阳性率低是Ⅴ型的预测指标。
- 红斑狼疮, 系统性 /
- 狼疮肾炎 /
- 蛋白尿
Abstract: Objective To establish a relative predictive model of pathology of lupus nephritis based on clinical and laboratory results. Methods Lupus nephritis patients who had renal biopsies were consecutⅣely recruited in our hospital from 2011 to 2015. 201 patients had already received an over two months treatment with glucocorticoid, but they still had positive proteinuria. The clinical manifestations and laboratory indexes of these patients were analyzed. Epi Data 3.1 and SPSS 21.0 were used for statistical analysis. Results Seventeen cases with class Ⅱ lupus nephritis, 26 cases with class Ⅲ lupus nephritis, 135 cases with class iv lupus nephritis and 23 cases with classⅤ lupus nephritis. In single analysis, patients with proliferative lupus nephritis were younger and had earlier first-onset age, higher SLEDAI, more anemia, lower serum levels of C3 complement components, higher positive rate of anti-C1q antibody (64.0%) and anti-dsDNA antibody (53.4%). Patients with membranous lupus nephritis had older first onset age and lower positive rate of anti-dsDNA antibody (13.0%). Proteinuria turned negative rate was 67.4% in the supine position in patients with mesangioproliferative lupus nephritis. In logistic regression anlysis, patients with mesangioproliferative lupus nephritis had lower SLEDAI and higher incidence of disappearance of the protein loss in the supine position. Patients with proliferative lupus nephritis had higher SLEDAI, positive rate of proteinuria and anti-dsDNA antibody. Patients with membranous lupus nephritis had later first-onset age and lower positive rate of anti-dsDNA antibody. Conclusions The predictive model of pathological classifications of lupus nephritis has been established. Lower SLEDAI and higher incidence of negative proteinuria test in the supine position could be the strong predictors for class Ⅱ lupus nephritis. Higher SLEDAI, positive rate of proteinuria and anti-dsDNA antibody may predict class Ⅲ or iv lupus nephritis. Later first-onset age and lower positive rate of anti-dsDNA antibody may predict class Ⅴ lupus nephritis.
- Lupus erythematosus, systemic /
- Lupus nephritis /
- Proteinuria

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参考文献(20)

Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited [J]. J Am Soc Nephrol, 2004,15(2):241-250.

Sun HO, Hu WX, Xie HL, et al. Long-term outcome of Chinese patients with membranous lupus nephropathy [J]. Lupus, 2008,17(1):56-61.

Rovin BH, Parikh SV, Alvarado A. The kidney biopsy in lupus nephritis: is it still relevant? [J].Rheum Dis Clin North Am, 2014,40(3):537-552.

Giannico G, Fogo AB. Lupus nephritis: is the kidney biopsy currently necessary in the management of lupus nephritis? [J]. Clin J Am Soc Nephrol, 2013,8(1):138-145.

Guedes Marques M, Cotovio P, Ferrer F, et al. Random spot urine protein/creatinine ratio: a reliable method for monitoring lupus nephritis? [J]. Clin Kidney J, 2013,6(6): 590-594.

Mok CC. Biomarkers for lupus nephritis: a critical appraisal [J]. J Biomed Biotechnol, 2010,2010:638413.

杨静,梁丹丹,章海涛,等. 不同亚型狼疮性肾炎患者临床病理特征和预后的比较 [J].肾脏病与透析肾移植杂志, 2015,24(3):201-206.

Villamin CA, Navarra SV. Clinical manifestations and clinical syndromes of Filipino patients with systemic lupus erythematosus [J]. Mod Rheumatol, 2008,18(2):161-164.

Guo Q, Lu X, Miao L, et al. Analysis of clinical manifestations and pathology of lupus nephritis: a retrospective review of 82 cases [J]. Clin Rheumatol, 2010,29(10):1175-1180.

Mavragani CP, Fragoulis GE, Somarakis G, et al. Clinical and laboratory predictors of distinct histopathogical features of lupus nephritis [J]. Medicine (Baltimore), 2015,94(21):e829.

Al-Zahrani IH, Qayyum A. Lupus nephritis. Clinicopathological correlation [J].Saudi Med J, 2007,28(10):1503-1505.

Shariati-Sarabi Z, Ranjbar A, Monzavi SM, et al. Analysis of clinicopathologic correlations in Iranian patients with lupus nephritis [J]. Int J Rheum Dis, 2013,16(6):731-738.

OLiveira RC, OLiveira IS, Santiago MB, et al. High avidity dsDNA autoantibodies in Brazilian women with systemic lupus erythematosus: correlation with active disease and renal dysfunction [J].J Immunol Res, 2015,2015:814748.

Birmingham DJ, Rovin BH, Shidham G,et al. Spot urine protein/creatinine ratios are unreliable estimates of 24 h proteinuria in most systemic lupus erythematosus nephritis flares [J]. Kidney Int, 2007,72(7):865-870.

Guedes Marques M, Cotovio P, Ferrer F, et al. Random spot urine protein/creatinine ratio: a reliable method for monitoring lupus nephritis? [J]. Clin Kidney J, 2013,6(6):590-594.

Salach RH, Cash JM. Managing lupus nephritis: algorithms for conservative use of renal biopsy [J]. Cleve Clin J Med,1996,63(2):106-115.

Christopher-Stine L, Siedner M, Lin J, et al. Renal biopsy in lupus patients with low levels of proteinuria [J]. J Rheumatol, 2007,34(2):332-335.

Nezhad ST, Sepaskhah R. Correlation of clinical and pathological findings in patients with lupus nephritis: a five-year experience in Iran [J]. Saudi J Kidney Dis Transpl, 2008,19(1):32-40.

de Joode AA, Sluiter HE. Orthostatic proteinuria: a harmless variant of protein loss? [J]. Neth J Med, 2011,69(2):62-65.

Shidham GB, Siddiqi N, Beres JA, et al. Clinical risk factors associated with bleeding after native kidney biopsy [J]. Nephrology (Carlton), 2005,10(3):305-310.

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