血清抗中性粒细胞胞质抗体阳性狼疮性肾炎患者的临床病理特征及预后

doi:10.3969/cndt.j.issn.1006-298X.2017.01.006

肾脏病与透析肾移植杂志 ›› 2017, Vol. 26 ›› Issue (1): 31-36.DOI: 10.3969/cndt.j.issn.1006-298X.2017.01.006

血清抗中性粒细胞胞质抗体阳性狼疮性肾炎患者的临床病理特征及预后

出版日期:2017-02-28 发布日期:2017-02-21

Clinicopathological characteristics and outcome of lupus nephritis with antineutrophil cytoplasmic antibody positivity

Online:2017-02-28 Published:2017-02-21

摘要/Abstract

摘要：

目的：回顾性分析血清抗中性粒细胞胞质抗体（ANCA）阳性狼疮性肾炎（LN）患者的临床、病理特征及预后。
方法：收集本中心1985年1月至2008年12月间明确诊断为血清ANCA阳性LN患者,回顾性分析其临床、病理特征及预后，对照组选取同期诊断为血清ANCA阴性LN患者。
结果：符合入选标准的49例患者中，38例MPOANCA阳性，7例PR3ANCA阳性，4例MPOANCA和PR3ANCA双阳性。女性40例、男性9例。中位年龄33岁。ANCA阳性LN患者，尿沉渣红细胞计数、血清肌酐、SLEDAI评分均高于对照组（P<005）；病理类型以LNⅣ型为主，占6122%；光镜下AI、CI评分均显著高于对照组（P<005）。ANCA阳性LN患者中，20例接受吗替麦考酚酸酯（MMF）诱导治疗，18例接受静脉环磷酰胺（CYC）诱导治疗，其余11例患者接受雷公藤多苷等治疗MMF组的完全缓解率（9000% vs 5556%， P=0027）和肾脏生存率（P=0039）均优于CYC组。ANCA阳性LN患者中位随访8783月，有7例患者(1429%)发生终末期肾病，均为MPOANCA阳性。
结论：血清ANCA阳性LN患者肾脏表现为大量的血尿、肾功能损害明显。这部分患者接受MMF诱导治疗，其完全缓解率和肾脏预后均优于CYC。

关键词: 狼疮性肾炎, 抗中性粒细胞胞质抗体, 临床表现, 病理特征, 治疗预后

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To assess the clinical features,pathological presentation and outcome of lupus nephritis(LN) with antineutrophil cytoplasmic antibody(ANCA) positive.
Ｍｅｔｈｏｄｏｌｏｇｙ：The pathology database at our institution was searched for cases that showed LN with ANCA positivity between January 1985 to December 2008. Their data were analyzed and compared with the control group.
Ｒｅｓｕｌｔｓ：The cohort consisted of 40 female and 9 male with an average age of 33 years at biopsy,including 38 MPOANCA,7 PR3ANCA and 4 with double positive. LN with ANCA positive exhibited higher hematuria,serum creatinine and SLEDAI score. On pathological evaluation,Class IV LN predominance was observed,accounting for 6122%. Light microscopy revealed significantly higher scores of AI and CI. Patients receiving mycophenolate mofetil (MMF) as induction therapy had higher complete remission and better renal outcome than those receiving cyclophosphamide. During followup,endstage renal disease developed in 7 (1429%) patients,all of whom were MPOANCA positive.
Ｃｏｎｃｌｕｓｉｏｎ：LN with ANCA positivity was characterized by massive hematuria,advanced renal insufficiency. Higher complete remission and better prognosis were observed when using MMF than cyclophosphamide as induction therapy.

李翠,周敏林,梁丹丹,等. 血清抗中性粒细胞胞质抗体阳性狼疮性肾炎患者的临床病理特征及预后[J]. 肾脏病与透析肾移植杂志, 2017, 26(1): 31-36.

LI Cui,ZHOU Minlin,LIANG Dandan, et al. Clinicopathological characteristics and outcome of lupus nephritis with antineutrophil cytoplasmic antibody positivity[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2017, 26(1): 31-36.

[1]	谢敏珠, 陈欣, 刘正钊, 章海涛, 罗松, 胡伟新. 狼疮性肾炎合并狼疮性肠炎患者的临床特征及远期疗效分析[J]. 肾脏病与透析肾移植杂志, 2021, 30(1): 19-24.
[2]	董建华，罗松，许书添，等. 狼疮性肾炎伴狼疮心肌炎的临床及心脏磁共振特征[J]. 肾脏病与透析肾移植杂志, 2020, 29(4): 301-306.
[3]	胡伟新. 羟氯喹在狼疮性肾炎的应用：老药新用，锦上添花[J]. 肾脏病与透析肾移植杂志, 2020, 29(4): 348-349.
[4]	赵亮,任贵生,郭锦洲,等. 系统性轻链型淀粉样变性累及肝脏的临床表现及预后[J]. 肾脏病与透析肾移植杂志, 2019, 28(4): 318-323.
[5]	章海涛,谌达程,周敏林, 等. 双重血浆置换治疗伴血栓性微血管病狼疮性肾炎的临床疗效[J]. 肾脏病与透析肾移植杂志, 2019, 28(3): 201-206.
[6]	苏丽雅·艾山江,叶力夏提·阿德力别克,桑晓红,等. 抗中性粒细胞胞质抗体相关性血管炎肾脏损害与血清C3的关系[J]. 肾脏病与透析肾移植杂志, 2019, 28(3): 229-234.
[7]	汤雄,张炯,余元蒙,等. 应用功能磁共振成像评估狼疮性肾炎患者肾功能预后[J]. 肾脏病与透析肾移植杂志, 2019, 28(2): 101-106.
[8]	杨静，杨爱祥，沈蕾. 肾小管间质性肾炎-眼色素膜炎综合征[J]. 肾脏病与透析肾移植杂志, 2019, 28(2): 176-180.
[9]	章海涛，周敏林，代敏，等. 双重血浆置换联合免疫抑制剂治疗重症狼疮性肾炎的疗效[J]. 肾脏病与透析肾移植杂志, 2019, 28(1): 13-18.
[10]	刘丹丹,龚德华,葛永纯,等. 连续性肾脏替代治疗重症狼疮性肾炎患者的预后及其影响因素[J]. 肾脏病与透析肾移植杂志, 2018, 27(6): 501-506.
[11]	钟翔，李欣忆，张萍，等. 狼疮性肾炎蛋白尿水平与肾小球病理改变的关系[J]. 肾脏病与透析肾移植杂志, 2018, 27(5): 407-411.
[12]	王晶晶，刘正钊，陈樱花，等. 钙神经调节蛋白抑制剂诱导治疗狼疮性肾炎的Meta分析[J]. 肾脏病与透析肾移植杂志, 2018, 27(5): 424-429.
[13]	张凯聪，张丽，梁馨苓. 狼疮性肾炎生物标志物[J]. 肾脏病与透析肾移植杂志, 2018, 27(5): 463-467.
[14]	李康，陈樱花，刘正钊，等. 狼疮性肾炎妊娠结局及影响因素[J]. 肾脏病与透析肾移植杂志, 2018, 27(4): 315-319.
[15]	吕亚男,李晓梅,梁少姗,等. 冷球蛋白血症相关肾小球肾炎患者的临床病理特征及预后分析[J]. 肾脏病与透析肾移植杂志, 2018, 27(3): 201-207.

ISSN 1006-298X CN 32-1425/R

血清抗中性粒细胞胞质抗体阳性狼疮性肾炎患者的临床病理特征及预后

Clinicopathological characteristics and outcome of lupus nephritis with antineutrophil cytoplasmic antibody positivity

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价