• 四川大學(xué)華西醫(yī)院腎臟內(nèi)科（成都，610041）;

【摘要】　目的　 發(fā)現(xiàn)提示早期Ⅴ型狼瘡性腎炎（lupus nephritis，LN）的指標(biāo)。　方法　 2004年 1月-2009年11月24例經(jīng)腎活檢診斷為Ⅴ型LN患者，與同期50例膜性腎病伴抗核抗體（antinuclear antibody，ANA）陽性患者、50例膜性腎病ANA陰性患者，以及13例膜性腎病ANA陽性且腎組織熒光為“滿堂亮”患者的一般資料、腎病表現(xiàn)、腎臟病理以及實(shí)驗(yàn)室指標(biāo)進(jìn)行比較。　結(jié)果　 Ⅴ型LN與膜性腎病ANA陰性的患者相比，兩組的性別、起病年齡、血紅蛋白、補(bǔ)體水平、內(nèi)皮和系膜增殖的比例等有明顯差異。膜性腎病ANA陽性患者的臨床和病理表現(xiàn)更接近于ANA陰性的膜性腎病，但其性別比仍以女性居多。而膜性腎病ANA陽性伴“滿堂亮”的患者在性別、腎病表現(xiàn)、血紅蛋白、補(bǔ)體水平等方面與Ⅴ型LN更為接近。　結(jié)論　 膜性腎病ANA陽性患者具有異質(zhì)性，其中腎臟病理表現(xiàn)為“滿堂亮”的患者可能系早期Ⅴ型LN。
【Abstract】　Objective　 To find out the clinical and pathological characteristics of early pure class Ⅴ lupus nephritis (LN).　Methods　 A total of 24 patients with pure class Ⅴ LN diagnosed between January 2004 and November 2009 were included, and were compared with 50 antinuclear antibody (ANA)-positive patients with membranous nephropathy (MN) and 50 ANA-negative patients with MN. The clinical and pathological characteristics, laboratory test results were compared between the two groups. Then, 13 patients with "full house" fluorescence in renal biopsy specimens were chosen from the group of ANA-positive membranous nephropathy, whose clinical characteristics and laboratory test were compared with class Ⅴ LN patients.　Results　 There were significant differences in sex ratio, age, positive rate of hepatitis B surface antigen (HBsAg), levels of hemoglobin, white blood cell, platelet,complement, endothelial and mesangial proliferation between class Ⅴ LN and ANA-negative MN group. However, the sex ratio, levels of white blood cell, platelet were similar between class Ⅴ LN and ANA-positive MN group. The renal biopsy specimens in patients with ANA-positive MN with "full house" fluorescence were similar with those in the patients with class Ⅴ LN in sex ratio, renal injury, hemoglobin and complement and the positive rate of hepatitis B surface antigen.　Conclusion　 The demographic information and clinical manifestations in patients with class Ⅴ LN were similar to those in patients with ANA positive MN, especially in the patients wiht ANA-positive MN with "full house" fluorescence in renal biopsy specimens.

引用本文： 陳曉涵,胡章學(xué). 純Ⅴ型狼瘡性腎炎與膜性腎病的臨床病理分析. 華西醫(yī)學(xué), 2011, 26(1): 22-25. doi: 復(fù)制

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  2. 2. 　Weening JJ, D’Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited[J]. Kidney Int, 2004, 65(2): 521-530.
  3. 3. 　Weening JJ, D’Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited[J]. J Am Soc Nephrol, 2004, 15(2): 241-250.
  4. 4. 　Bombardier C, Gladman DD, Urowitz MB, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The committee on prognosis studies in SLE[J]. Arthritis Rheum, 1992, 35(6): 630-640.
  5. 5. 　Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group[J]. Ann Intern Med, 1999, 130(6): 461-470.
  6. 6. 　全國eGFR課題協(xié)作組. MDRD方程在我國慢性腎臟病患者中的改良和評估[J]. 中華腎臟病雜志, 2006: 22(10): 589-595.
  7. 7. 　陳強(qiáng), 胡偉新, 劉志紅, 等. 152例V型狼瘡腎炎的臨床病理研究[J]. 中華腎臟病雜志, 2002, 18(6): 417-421.
  8. 8. 　Adu D, Williams DG, Taube D, et al. Late onset systemic lupus erythematosus and lupus-like disease in patients with apparent idiopathic glomerulonephritis[J]. Q J Med, 1983, 52(208): 471-487.