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目的 :探讨弥漫增生性狼疮性肾炎 (DPLN)不同类型肾间质血管病变与临床和预后的关系。 方法 :根据光镜和免疫荧光检查将 16 9例DPLN的肾间质血管病变分为 :无血管病变型 (NRVL ,n =84例 ) ,免疫复合物沉积型 (ICD ,n =11例 ) ,非炎症性坏死性血管病变型 (NNV ,n =2 7例 ) ,血栓性微血管病型 (TMA ,n =14例 ) ,血管炎型 (VAS ,n =1例 )和动脉硬化型 (AS ,n =32例 ) 6种类型。回顾性分析各型血管病变的临床特点与预后的关系。结果 :① 16 9例患者中 ,85例 (5 0 3%)存在肾间质血管病变。其中AS型 18 9%,NNV型 16 %,TMA型 8 3%,ICD型6 5 %,VAS型 0 6 %;②肾损害 :TMA型、NNV型肾功能不全发生率显著高于ICD型、AS型和NRVL型 ,分别为92 9%、5 9 3%、45 5 %、34 4 %和 2 0 2 %,TMA型SCr水平最高。肾小球新月体形成 >5 0 %患者比例TMA型(35 7%)、NNV型 (14 8%)明显高于其它各型 ,慢性化指数亦显著高于其它各型 ;③肾外损害 :TMA型、NNV型贫血严重 ,浆膜腔炎发生率高 ,TMA型白细胞、血小板减少发生率显著高于其它各型 ,但皮肤损害少见 ;④血清学指标 :ACL阳性率在TMA型最高 (33 3%) ,ANCA阳性率在NNV型 (2 2 7%)和TMA型 (16 7%)较高 ,但与其它各型无统计学差异。ANA、抗ds DNA和抗Sm抗体阳性率和血补
Objective: To investigate the relationship between different types of renal interstitial vascular lesions and the clinical and prognosis of diffuse proliferative lupus nephritis (DPLN). Methods: The renal interstitial vascular lesions of 16 9 DPLN patients were divided into three groups according to light microscope and immunofluorescence: no vascular lesions (n = 84), immune complex deposition (ICD, n = 11) Non-inflammatory necrotic vascular lesions (NNV, n = 27), thrombotic microangiopathy (TMA, n = 14), vasculitis (VAS, n = 1) and atherosclerotic (AS, n = 32) 6 types. The clinical characteristics and prognosis of various types of vascular lesions were retrospectively analyzed. Results: Among the 16 9 patients, 85 (53.03%) had renal interstitial vascular lesions. Among them, AS type was 18 9%, NNV type was 16%, TMA type was 8 3%, ICD type was 6 5% and VAS type was 0 6%. ② Renal impairment: The incidence of TMA type and NNV type renal insufficiency was significantly higher than that of ICD type, Type AS and Type NRVL were 92 9%, 59 3%, 45 5%, 34 4% and 202% respectively, with the highest level of TMA-type SCr. Glomerular crescent formation> 50% of patients with TMA type (35.7%), NNV type (14.8%) was significantly higher than the other types, the chronicity index was also significantly higher than the other types; ③ extrahepatic lesions : TMA-type, NNV-type anemia, the incidence of serosal inflammation, TMA-type leukocytes, thrombocytopenia was significantly higher than other types, but rare skin damage; ④ serological indicators: ACL positive rate in the TMA highest 33 3%). The ANCA positive rate was higher in NNV type (22.7%) and TMA type (16.7%), but no significant difference with other types. ANA, anti-ds DNA and anti-Sm antibody positive rate and blood supply