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目的:观察狼疮性肾炎(LN)伴急性肾损伤(AKI)患者的临床及病理特点。方法:选择LN伴AKI 61例,另外选择同期无AKI的LN 60例为对照组。观察比较两组临床及病理特点。结果:(1)观察组浆膜炎发生率83.6%,显著高于对照组的61.7%(P<0.05);肾病综合征发生率68.9%,显著高于对照组的48.3%(P<0.05)。观察组Scr和尿蛋白水平,均较对照组显著升高(P<0.05)。(2)两组抗核抗体(ANA)阳性率、抗双链DNA抗体(ds-DNA)阳性率、抗Sm抗体阳性率及补体C3降低比例,均差异不显著(P>0.05)。观察组肾脏免疫荧光出现“满堂亮”现象比例93.4%,显著高于对照组的58.3%(P<0.05)。(3)观察组细胞性新月体、毛细血管袢坏死、透明血栓及“白金耳”等病理特点出现率,均非常显著高于对照组(P<0.01)。结论:LN伴AKI患者的临床症状及病理表现较严重,宜及早诊断、积极治疗。
Objective: To observe the clinical and pathological features of patients with lupus nephritis (LN) and acute kidney injury (AKI). Methods: Sixty-one LN patients with AKI were selected. Another 60 LN patients without AKI during the same period were selected as control group. The clinical and pathological features of the two groups were observed and compared. Results: (1) The incidence of serositis in the observation group was 83.6%, significantly higher than that in the control group (61.7%, P <0.05). The incidence of nephrotic syndrome was 68.9%, significantly higher than that in the control group (48.3% . Scr and urinary protein levels in the observation group were significantly higher than those in the control group (P <0.05). (2) The positive rate of anti-nuclear antibody (ANA), the positive rate of anti-double-stranded DNA antibody (ds-DNA), the positive rate of anti-Sm antibody and the proportion of complement C3 were not significantly different (P> 0.05). The immunofluorescence of the observation group appeared 93.4% of the cases, which was significantly higher than that of the control group (58.3%, P <0.05). (3) The incidences of cellular crescent, capillary necrosis, clear thrombus and pathological features such as “white ear” in the observation group were significantly higher than those in the control group (P <0.01). Conclusion: The clinical symptoms and pathological findings of patients with LN and AKI are more serious and should be diagnosed and treated actively.