纯Ⅴ型狼疮性肾炎与膜性肾病的临床病理分析

【】　目的　发现提示早期Ⅴ型狼疮性肾炎（lupusnephritis，LN）的指标。　方法　2004年1月-2009年11月24例经肾活检诊断为Ⅴ型LN患者，与同期50例膜性肾病伴抗核抗体（antinuclearantibody，ANA）阳性患者、50例膜性肾病ANA阴性患者，以及13例膜性肾病ANA阳性且肾组织荧光为“满堂亮”患者的一般资料、肾病表现、肾脏病理以及实验室指标进行比较。　结果　Ⅴ型LN与膜性肾病ANA阴性的患者相比，两组的性别、起病年龄、血红蛋白、补体水平、内皮和系膜增殖的比例等有明显差异。膜性肾病ANA阳性患者的临床和病理表现更接近于ANA阴性的膜性肾病，但其性别比仍以女性居多。而膜性肾病ANA阳性伴“满堂亮”的患者在性别、肾病表现、血红蛋白、补体水平等方面与Ⅴ型LN更为接近。　结论　膜性肾病ANA阳性患者具有异质性，其中肾脏病理表现为“满堂亮”的患者可能系早期Ⅴ型LN。？【Abstract】　Objective　TofindouttheclinicalandpathologicalcharacteristicsofearlypureclassⅤlupusnephritis(LN).　Methods　Atotalof24patientswithpureclassⅤLNdiagnosedbetweenJanuary2004andNovember2009wereincluded,andwerecomparedwith50antinuclearantibody(ANA)-positivepatientswithmembranousnephropathy(MN)and50ANA-negativepatientswithMN.Theclinicalandpathologicalcharacteristics,laboratorytestresultswerecomparedbetweenthetwogroups.Then,13patientswith"fullhouse"fluorescenceinrenalbiopsyspecimenswerechosenfromthegroupofANA-positivemembranousnephropathy,whoseclinicalcharacteristicsandlaboratorytestwerecomparedwithclassⅤLNpatients.　Results　Thereweresignificantdifferencesinsexratio,age,positiverateofhepatitisBsurfaceantigen(HBsAg),levelsofhemoglobin,whitebloodcell,platelet,complement,endothelialandmesangialproliferationbetweenclassⅤLNandANA-negativeMNgroup.However,thesexratio,levelsofwhitebloodcell,plateletweresimilarbetweenclassⅤLNandANA-positiveMNgroup.TherenalbiopsyspecimensinpatientswithANA-positiveMNwith"fullhouse"fluorescenceweresimilarwiththoseinthepatientswithclassⅤLNinsexratio,renalinjury,hemoglobinandcomplementandthepositiverateofhepatitisBsurfaceantigen.　Conclusion　ThedemographicinformationandclinicalmanifestationsinpatientswithclassⅤLNweresimilartothoseinpatientswithANApositiveMN,especiallyinthepatientswihtANA-positiveMNwith"fullhouse"fluorescenceinrenalbiopsyspecimens.