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目的:探讨伴抗磷脂综合征(APS)狼疮性肾炎(LN)患者的临床病理特点及肾脏远期预后。方法:回顾性分析2002年至2014年期间在南京军区南京总医院肾脏科经肾活检确诊为LN且符合APS分类标准的汉族患者,并与同期不伴APS的LN患者比较,分析其临床表现、肾组织病理特点及肾脏远期预后差异。结果:共收集53例合并APS的LN患者,随机选择106例不伴APS的LN患者,发现APS组患者在狼疮活动、血栓发生、心脏受累及抗凝药物的应用上明显高于对照组(P<0.05);而在LN病程、高血压、蛋白尿、血尿、血清白蛋白(Alh)、血清肌酐(SCr)、血红蛋白(Hb)、自细胞(WBC)、血小板(PLT)减少、自身抗体、补体水平及诱导方案的选择和治疗反应方面无明显差异。APS组患者血栓性微血管病所占比例更高。随访63.7个月两组肾脏存活率未见统计学差异。结论:伴APS的LN患者疾病活动性更强、血栓事件和心脏受累更为常见,抗凝应用更为积极,但肾脏预后与不伴APS的患者未见明显统计学差异。
Objective: To investigate the clinicopathological features and renal long-term prognosis of patients with antiphospholipid syndrome (APS) lupus nephritis (LN). Methods: We retrospectively analyzed the Han nationality who were diagnosed as LN by renal biopsy and the APS classification criteria in the Nanjing General Hospital of Nanjing Military Region from 2002 to 2014. The clinical data were compared with LN patients without APS during the same period. Pathological features of kidney and long-term renal prognosis. Results: A total of 53 patients with LN with APS were randomly selected from 106 LN patients without APS. The results showed that patients with APS were significantly more likely to have lupus activity, thrombosis, cardiac involvement and anticoagulant therapy than those of the control group (P (P <0.05). However, there was no significant difference in the course of LN, hypertension, proteinuria, hematuria, Alh, SCr, Hb, WBC and PLT, There was no significant difference in complement level and induction regimen choice and treatment response. APS group of patients with higher proportion of thrombotic microvascular disease. 63.7 months follow-up renal survival rate was no significant difference between the two groups. CONCLUSIONS: LN patients with APS have more active disease, thrombotic events and heart involvement are more common, and anticoagulation is more active. However, there is no significant difference between LN patients with and without APS.