本文選題：系統(tǒng)性紅斑狼瘡 + 狼瘡性腎炎　； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：本研究通過對腎損害首發(fā)的系統(tǒng)性紅斑狼瘡患者的病歷資料進(jìn)行回顧性分析，與皮膚損害首發(fā)、關(guān)節(jié)肌肉損害首發(fā)、血液系統(tǒng)損害首發(fā)、發(fā)熱首發(fā)等非腎損害首發(fā)的SLE患者進(jìn)行對比，總結(jié)SLE患者中腎損害首發(fā)者的臨床表現(xiàn)、伴隨癥狀、一般實驗室檢查、病理特點，探討狼瘡性腎炎的早期診斷。 方法：回顧性分析2009年1月至2014年12月間于吉林大學(xué)第二醫(yī)院就診明確診斷為SLE并住院治療的437例患者，以腎損害首發(fā)的143例為研究對象，非腎損害首發(fā)的294例包括皮膚損害首發(fā)的115例、關(guān)節(jié)肌肉損害首發(fā)的63例、血液系統(tǒng)損害首發(fā)42例、發(fā)熱首發(fā)52例、心臟損害首發(fā)7例、呼吸系統(tǒng)損害首發(fā)6例、神經(jīng)系統(tǒng)損害首發(fā)6例、消化系統(tǒng)損害首發(fā)3例作為對照，詳細(xì)記錄性別、年齡、病情活動度評分、伴隨的臨床癥狀、實驗室指標(biāo)包括常規(guī)實驗室檢查和免疫學(xué)檢查，以及腎臟損害首發(fā)者81例和非腎臟損害首發(fā)者94例共175例行腎穿刺術(shù)患者的腎穿病理資料，應(yīng)用統(tǒng)計學(xué)方法分析后得出相應(yīng)結(jié)果。 結(jié)果：1）SLE患者發(fā)病有明顯的性別傾向，男女比例為1:8.71，男性年齡13~84歲（39.01±17.091），，女性年齡7~80歲（38.08±14.23）；2）SLEDAI評分評價患者病情活動度，腎損害首發(fā)組以病情重度活動為主，以基本無活動的比例最�。�3）腎損害首發(fā)組患者較易合并血液系統(tǒng)損害、關(guān)節(jié)肌肉損害、脫發(fā)、皮膚損害等，明確SLE或LN診斷前主要診斷為腎病綜合征、慢性腎炎、蛋白尿、慢性腎功能衰竭、急性腎損害等，多就診于腎風(fēng)濕科；4）腎損害首發(fā)組腎臟損害相關(guān)的實驗室指標(biāo)異常的陽性率均高于非腎損害首發(fā)組；5）免疫學(xué)指標(biāo)腎損害首發(fā)組IgG和CRP升高的比例小于非腎損害首發(fā)組，C4降低的比例大于非腎損害首發(fā)組，有統(tǒng)計學(xué)差異。6）腎損害非首發(fā)組抗dsDNA抗體陽性率（76.44%）明顯高于腎損害首發(fā)組（62.43%）和腎臟未受累組（37.70%），P分別為0.009和0＜0.01，有統(tǒng)計學(xué)顯著差異。在SLE腎臟受累的患者中抗dsDNA陽性率比AnuA高，P=0＜0.01，兩檢測方法差異有統(tǒng)計學(xué)意義。AnuA、抗U1RNP抗體、抗Sm抗體、抗SSB抗體、抗組蛋白抗體陽性率、Anti-P陽性率在各組間無顯著差異。7）腎損害首發(fā)組與非腎損害首發(fā)組病理類型以Ⅳ型和Ⅳ+Ⅴ型為主，腎損害首發(fā)組Ⅳ型比例高于非腎損害首發(fā)組，Ⅱ型LN的比例低于非腎損害首發(fā)組，有統(tǒng)計學(xué)差異。8）Ⅲ型LN患者主要表現(xiàn)為慢性腎炎，Ⅳ型、Ⅴ型、Ⅲ+Ⅴ型及Ⅳ+Ⅴ型主要表現(xiàn)為腎病綜合征。9）腎損害首發(fā)組各病理類型均易合并血液系統(tǒng)損害。 結(jié)論：1）SLE患者常見腎損害，且常常是首發(fā)表現(xiàn)；2）在SLE患者中，抗dsDNA抗體具有腎臟損害特異性，且比ANuA更敏感；3）兩組LN患者腎活檢病理類型以Ⅳ型為主，其次是Ⅳ+Ⅴ型；4）腎損害臨床表現(xiàn)不同的SLE患者均可出現(xiàn)典型的腎臟病理學(xué)改變。
[Abstract]:Objective: through retrospective analysis of the medical records of patients with systemic lupus erythematosus (SLE) with renal damage, the first episode was with skin damage, joint and muscle damage, and blood system damage. In order to explore the early diagnosis of lupus nephritis, the clinical manifestations, associated symptoms, general laboratory examination and pathological features of the patients with SLE were summarized. Methods: from January 2009 to December 2014, 437 patients who were diagnosed as SLE and hospitalized at the second Hospital of Jilin University were retrospectively analyzed. 294 cases of non-renal lesion included 115 cases of skin damage, 63 cases of joint and muscle damage, 42 cases of blood system damage, 52 cases of fever, 7 cases of heart damage and 6 cases of respiratory system damage. The first 6 cases of nervous system damage and 3 cases of digestive system damage were used as control. Gender, age, disease activity score, clinical symptoms, laboratory indexes including routine laboratory examination and immunological examination were recorded in detail. Renal biopsy data of 175 cases of renal puncture in 81 cases of renal injury and 94 cases of non-renal lesion were analyzed by statistical method. Results there was a significant sexual tendency in the onset of SLE in the male and female patients, the male / female ratio was 1: 8.71, the male age was 139.01 鹵17.091g, the female age was 78.08 鹵14.232SLEDAI, and the severity of the disease was the main activity in the first group of renal damage. Patients in the initial group of renal damage were more likely to be complicated with hematological damage, joint muscle damage, alopecia, skin damage and so on. It was clear that SLE or LN were mainly diagnosed as nephrotic syndrome, chronic nephritis, proteinuria before diagnosis. Chronic renal failure, acute renal damage, etc. The positive rate of abnormal laboratory indexes related to renal damage in the first renal lesion group was higher than that in the non-renal lesion initial group (5) the proportion of IgG and CRP increased in the first renal lesion group was lower than that in the non-renal lesion first group. The rate of decrease of C _ 4 in hair group was higher than that in non-renal lesion group. The positive rate of anti-dsDNA antibody in the non-initial group of renal damage was significantly higher than that in the first group of renal damage (62.43) and the unaffected group was 37. 70% (P < 0. 01), which was significantly higher than that in the non-initial group of renal damage (P < 0. 01). The positive rate of anti dsDNA in patients with renal involvement of SLE was higher than that of AnuA. The difference between the two methods was statistically significant. Anua, anti U1RNP antibody, anti Sm antibody, anti SSB antibody, The positive rate of anti-histone antibody and Anti-P positive rate were not significantly different among the groups. 7) the pathological types of renal lesion first group and non-renal lesion initial group were mainly type 鈪

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