摘要
目的:探讨狼疮性肾炎(LN)病理类型与实验室指标和临床特点关系.方法:选自我院2020 年1 月至2023 年2 月LN患者406 例作为研究对象,将LN分为六型,包括Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型和复合型,其中复合型为Ⅱ+Ⅴ型、Ⅲ+Ⅴ型、Ⅳ+Ⅴ型.分析LN临床分型与病理类型关系,LN临床表现与病理类型关系,LN活动性评分与病理类型的关系,LN 病理活动指数与临床指标相关性.结果:LN患者406 例中,以肾脏首发型 273 例占比最高,为 67.24%,Ⅱ型、Ⅳ型、Ⅴ型和复合型高于Ⅲ型(P<0.05);无症状型Ⅱ型高于Ⅳ型、Ⅴ型和复合型(P<0.05);肾炎综合征Ⅲ型高于Ⅳ型(P<0.05);Ⅳ型、Ⅴ型和复合型肾病综合征高于Ⅱ型(P<0.05);Ⅳ型肾功能不全高于Ⅱ型(P<0.05).Ⅳ型和复合型高血压检出率显著高于其它类型(P<0.05);Ⅳ型血尿高于其它类型(P<0.05);Ⅴ型、Ⅳ型和复合型低蛋白血症、大量蛋白尿高于Ⅱ型和Ⅲ型(P<0.05);Ⅳ型血肌酐高于其它类型(P<0.05);Ⅳ型贫血高于其它类型(P<0.05);不同病理类型抗ds-DNA抗体阳性率比较差异有统计学意义(P<0.05),而其中抗 ds-DNA抗体阳性率中以Ⅴ型最低、Ⅳ型最高;低 C3 检出率中,Ⅳ型高于其它类型(P<0.05);低 C3 和低C4 检出率中,Ⅴ型低于其它类型(P<0.05).相比于其他类型,Ⅳ型AI和SLEDAI评分最高(P<0.05);相比于其他类型,复合型 CI 评分最高(P<0.05).AI 与血小板计数、C3、C4 呈线性负相关,与 24Upro、SLEDAI呈线性正相关(P<0.05);肌酐与AI、CI均呈正相关(P<0.05).结论:增殖型是LN常见病理类型,且最常见为Ⅳ型;LN病理类型与临床特点和实验室指标相关,值得临床借鉴.
Abstract
Objective:To investigate the correlation between pathological types of lupus nephritis(LN)and laboratory indicators and clinical features.Methods:A total of 406 patients with LN who were admitted to our hospital from January 2020 to February 2023 were selected as the research subjects.LN was divided into six types,including Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,and composite types,of which the composite type was Ⅱ + Ⅴ,Ⅲ + Ⅴ,and Ⅳ + Ⅴ.The relationship between LN clinical classification and pathological type,LN clinical manifesta-tions and pathological type,LN activity score and pathological type,and LN pathological activity index and clinical indicators were analyzed.Results:Among the 406 patients with LN,273 cases(67.24％)were of re-nal onset type,which was the highest,and the incidence rates of types Ⅱ,Ⅳ,Ⅴ,and composite type were higher than that of type Ⅲ(P<0.05).The incidence rate of asymptomatic type Ⅱ was higher than that of types Ⅳ,Ⅴ,and composite type(P<0.05).The incidence rate of nephritic syndrome in type Ⅲ was higher than that in type Ⅳ(P<0.05).The incidence rates of nephrotic syndrome in types Ⅳ,Ⅴ,and composite type were higher than that in type Ⅱ(P<0.05).The incidence rate of renal insufficiency in type Ⅳ was high-er than that in type Ⅱ(P<0.05).The detection rates of hypertension in types Ⅳ and composite type were sig-nificantly higher than those in other types(P<0.05).The incidence rate of hematuria in type Ⅳ was higher than that in other types(P<0.05).The incidence rates of hypoproteinemia and massive proteinuria in types Ⅴ,Ⅳ,and composite type were higher than those in types Ⅱ and Ⅲ(P<0.05).The level of serum creati-nine in type Ⅳ was higher than that in other types(P<0.05).The incidence rate of anemia in type Ⅳ was higher than that in other types(P<0.05).The positive rates of anti-dsDNA antibody in different pathological types were statistically different(P<0.05),and the positive rate of anti-dsDNA antibody was the lowest in type Ⅴ and the highest in type Ⅳ.The detection rate of low C3 was higher in type Ⅳ than in other types(P<0.05).The detection rates of low C3 and low C4 were lower in type Ⅴ than in other types(P<0.05).Com-pared with other types,the AI and SLEDAI scores in type Ⅳ were the highest(P<0.05).Compared with other types,the CI score in the composite type was the highest(P<0.05).AI was negatively correlated with platelet count,C3,and C4,and positively correlated with 24Upro and SLEDAI(P<0.05).Serum creatinine was positively correlated with AI and CI(P<0.05).Conclusion:The proliferative type is the most common pathological type of LN,and the most common type is Ⅳ.The pathological type of LN is correlated with clini-cal features and laboratory indicators,which is worth considering in clinical practice.
基金项目
河北省医学科学研究课题(2020)(20200907)
维普
万方数据