狼疮性肾炎患者尿蛋白量与肾脏病理改变相关性研究

Relationship between the level of proteinuria and renal pathological changes in patients with lupus nephritis

关键词:  狼疮性肾炎  尿蛋白  病理  相关性

Key words:  lupus nephritis  proteinuria  pathology  correlation

摘要:

［目的］从不同层面深入探讨狼疮性肾炎患者尿蛋白量与肾脏病理改变的关系。［方法］收集328例LN患者临床和病理资料，病理改变根据2003年ISN/RPS的标准进行分型，与患者24 h尿蛋白量作相关统计分析。［结果］328例LN患者各病理类型之间24 h尿蛋白量差异有显著性意义（P<0.05），相关分析提示24 h尿蛋白量与病理类型存在等级相关关系，相关系数 r=0.405 （P=0.0001）；与AI、CI、IAI及TIL也存在正相关关系（P<0.05），而与VL无相关性（P=0.683）。多因素相关回归分析发现24 h尿蛋白量与肾脏病变中的纤维素样坏死，透明血栓，“白金耳”改变，肾小球硬化，肾小管变性、坏死，间质炎性细胞浸润，间质纤维化存在正相关关系（P<0.05）；而与细胞增殖，新月体，肾小管萎缩的相关性无统计学意义。［结论］狼疮性肾炎患者尿蛋白量与肾脏病理改变存在一定的相关关系，结合其内在联系可推断肾脏病理改变，指导治疗和评价预后。

Abstract:

［Objective］To investigate the relationship between the level of proteinuria and renal pathological changes in patients with lupus nephritis (LN).［Methods］We collected clinical and renal pathological data of 328 patients with LN admitted to our hospital. Pathological classification was based upon the standard criteria of 2003 ISN/RPS, and made correlation analysis to the level of proteinuria.［Results］There were significant differences in 24 hours urine protein in six pathological types(P<0.05)in the 328 patients with LN. Through correlation analyses, we found rank correlation between the level of proteinuria and renal pathological type, r=0.405(P=0.0001), the positive correlation between proteinuria and AI,CI,IAI,TIL were also found respectively, but not found to VL(P=0.683). Multivariate 1ogistic regression analyses showed there existed positive correlation between urine protein and some renal pathological changes, included fibrinoid necrosis, hyaline thrombus, “wire loop” change, glomerular sclerosis, degeneration and necrosis of renal tubular, interstitial inflammatory cell infiltrate and fibrosis, but no significant correlation to cell proliferation, crescent, atrophy of renal tubular.［Conclusions］A positive correlation was demonstrated between the degree of 24 hours urine protein and renal pathological changes of lupus nephritis; According to the correlation, pathological changes could be foretold, and also be helpful to us in designing of therapeutic regimen and predicting of prognosis in lupus nephritis.