【摘要】：目的 通過系統(tǒng)回顧分析13年間系統(tǒng)性紅斑狼瘡(systemic lupus erythematosus, SLE)伴腎臟系統(tǒng)受累住院患者的臨床表現(xiàn)、實驗室檢查及影像學檢查,為及時診斷、及時治療及改善SLE患者的預后提供臨床依據(jù)。方法 回顧性分析1990年1月至2013年1月在昆明醫(yī)科大學第二附屬醫(yī)院診斷明確、資料完整的1029例SLE住院患者,對有腎臟系統(tǒng)損傷的552例患者臨床表現(xiàn)、實驗室檢查、影像學檢查進行統(tǒng)計分析。結果1.1990年1月-2013年1月住院治療的SLE患者1029例,其中符合狼瘡腎炎(lupus nephritis, LN)診斷標準的患者399例(38.78%),男47例,女352例(男：女=1：7.49)。有腎損害未達到LN標準的153例(12.15%),男19例,134例(男：女=1：7.05)。無腎臟損害組477例(46.36%),男45例,女432例(男：女=1：9.60)。3組間性別比率無明顯差異(P=0.263)。三組患者的好發(fā)年齡均在30～40歲,女性患病率遠高于男性,有腎損害的患者發(fā)病年齡較輕,平均年齡(32.25土13.34歲),病程較短,平均病程為43.38土5.25月。2.SLE患者臨床有腎臟損害表現(xiàn)552例(53.7%),行腎臟活檢LN患者的病理分型中,Ⅳ型最為多見38例(43.7%),且腎臟損害表現(xiàn)最突出。3.SLE有腎臟損害表現(xiàn)者抗核小體抗體陽性率顯著高于無腎臟損害表現(xiàn)者,且ds-DNA抗體滴度明顯增高,其中Ⅳ型ds-DNA抗體陽性率、抗SSA抗體陽性率明顯高于其他類型(P0.05)。4. SLEDAI評分以LN組最高(10.86±0.26),差異有顯著性(P0.000)。5.多因素Logistic回歸分析提示血紅蛋白和補體與SLEDAI呈負相關；高齡、病情活動、補體C3水平重度降低者腎功能損害重、病理分型較嚴重；而低齡、病情穩(wěn)定、補體正�；蜉p度降低者,腎功能損害較輕,病理分型較輕。結論SLE常累及腎臟,LN的臨床表現(xiàn)和實驗室指標與其病理類型存在一定的聯(lián)系,根據(jù)臨床表現(xiàn)和實驗室指標可以在一定程度上評估LN的嚴重程度,但是仍不能替代腎活檢在LN病理診斷中的重要價值。
[Abstract]:Objective to analyze the clinical manifestations, laboratory and imaging findings of systemic lupus erythematosus (systemic lupus erythematosus, SLE) patients with renal system involvement during the past 13 years. Timely treatment and improvement of the prognosis of patients with SLE provide clinical basis. Methods from January 1990 to January 2013, a total of 1029 SLE patients with definite diagnosis and complete data were analyzed retrospectively. The clinical manifestations and laboratory findings of 552 patients with renal system injury were analyzed. The imaging examination was analyzed statistically. Results 1. 1029 SLE patients were admitted from January 1990 to January 2013, including 399 patients (38.78%) who met the (lupus nephritis, LN) diagnostic criteria for lupus nephritis, 47 males and 352 females (male: female = 1: 7.49). There were 153 cases (12.15%) with kidney damage below LN standard, 19 cases were male, 134 cases (male: female = 1: 7.05). There were 477 cases (46.36%) without renal damage, 45 males and 432 females (males: females = 1: 9.60). The predilection age of the three groups was 30 to 40 years old. The prevalence rate of female was much higher than that of male. The average age (32.25 鹵13.34 years) of the patients with renal damage was lower, and the course of disease was shorter. The average course of disease was 43.38 鹵5.25 months. There were 552 cases (53.7%) with renal damage in 2.SLE patients, 38 cases (43.7%) were type 鈪，

本文編號：2328217