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目的:比较Ⅲ型与Ⅲ+Ⅴ型、Ⅳ型与Ⅳ+Ⅴ型及Ⅳ-S亚型与Ⅳ-G亚型狼疮性肾炎(LN)患者的临床病理特点和肾脏远期预后。方法:收集南京军区南京总医院肾脏科肾脏病登记系统中经肾活检明确诊断为增生型LN、随访时间≥1年的汉族成年患者肾活检时的临床和病理资料。观察终点为终末期肾病(ESRD)。病理分型参照ISN/RPS 2003病理分型方案。结果:Ⅲ型LN患者10年和20年肾脏生存率分别为92.1%和72.2%,Ⅲ+Ⅴ型分别为91.5%和88.9%,Ⅳ型分别为82.7%和60.3%(其中Ⅳ-S亚型分别为86.2%和69.6%;Ⅳ-G亚型分别为81.9%和58.9%),Ⅳ+Ⅴ型分别为82.7%和54.7%。Ⅲ+Ⅴ型和Ⅳ+Ⅴ型LN患者尿蛋白分别重于Ⅲ型和Ⅳ型患者;病理上慢性化病变分别重于Ⅲ型和Ⅳ型患者;急性病变分别轻于Ⅲ型和Ⅳ型患者。Ⅳ-S亚型LN患者抗中性粒细胞胞质抗体阳性率高于Ⅳ-G亚型患者;高血压、蛋白尿、低补体血症轻于Ⅳ-G亚型患者;病理上节段性袢坏死和新月体重于Ⅳ-G亚型患者;白金耳、毛细血管内增生轻于Ⅳ-G亚型患者。结论:Ⅲ型与Ⅲ+Ⅴ型、Ⅳ型与Ⅳ+Ⅴ型、Ⅳ-S亚型与Ⅳ-G亚型LN患者之间虽然临床病理特点不同,但肾脏生存率均无差异。
Objective: To compare the clinicopathological features and long-term renal prognosis of patients with type Ⅲ and Ⅲ + Ⅴ, Ⅳ and Ⅳ + Ⅴ and Ⅳ-S and Ⅳ-G subtypes of lupus nephritis (LN). Methods: The clinical and pathological data of renal biopsy in adults of Han nationality who were diagnosed as proliferative LN by renal biopsy and followed up for more than one year were collected from the Department of Nephrology, Nanjing General Hospital of Nanjing Military Command. The end point was end stage renal disease (ESRD). Pathological classification according to ISN / RPS 2003 pathological typing program. Results: The 10-year and 20-year renal survival rates of patients with type Ⅲ LN were 92.1% and 72.2%, respectively, with 91.5% and 88.9% for type Ⅲ + V and 82.7% and 60.3% for type Ⅳ, respectively 86.2% and 69.6%, respectively. The Ⅳ-Ⅴ subtypes were 81.9% and 58.9%, respectively), and Ⅳ + Ⅴ were 82.7% and 54.7% respectively. Patients with type Ⅲ + Ⅴ and type Ⅳ + Ⅴ of urinary protein were heavier than those with type Ⅲ and type Ⅳ respectively. Patients with pathologically chronic disease were more severe than those with type Ⅲ and Ⅳ respectively. Acute lesions were lighter than those with type Ⅲ and Ⅳ. The positive rate of anti-neutrophil cytoplasmic antibody in LN patients with Ⅳ-S subtype was higher than that in subgroup Ⅳ-G patients. Hypertension, proteinuria and hypocomplementemia were lighter than those in subgroup Ⅳ-G. The pathological segmental袢 necrosis and crescent weight in patients with Ⅳ-G subtype; platinum ear, capillary hyperplasia lighter than Ⅳ-G subtype. CONCLUSION: Although there are different clinical and pathological features between patients with type Ⅲ and Ⅲ + Ⅴ, Ⅳ and Ⅳ + Ⅴ, Ⅳ-S and Ⅳ-G, LN has no difference in renal survival.