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目的 :探讨狼疮性肾炎 (LN)患者肾小管间质病变及其临床意义。方法 :根据肾小管间质病变程度 (TIL)评分标准对 5 1例LN患者肾活检组织进行分级 ,并结合临床资料观察不同LN肾小管间质损害程度与活动指数(AI)、慢性指数 (CI)、病理分型、蛋白尿、肾功能及其他实验室检查结果之间的关系。结果 :5 1例LN患者伴有肾小管间质病变者 4 9例 (96 % )。对不同程度肾小管间质病变分级LN患者的AI、CI、TIL进行评分 ,Ⅱ级AI评分最高 ,与其他级别比较 ,差异有统计学意义 (P <0 .0 5 ) ;CI和TIL均以Ⅲ级评分最高 ,差异有统计学意义 (P <0 .0 1,P <0 .0 5 )。病理类型为Ⅳ型的LN患者肾小管间质病变程度显著高于其他病理类型。相关分析显示 ,LN患者TIL与AI、CI、Scr及Ccr水平相关 ,r分别为 0 .373(P <0 .0 1)、0 .813(P <0 .0 1)、0 .396 (P <0 .0 5 )、- 0 .4 76 (P <0 .0 5 ) ,与 2 4h尿蛋白定量等无相关性。结论 :LN肾小管间质病变与病理类型、肾功能损害程度、活动指数及慢性化程度具有一定的相关性 ,提示肾小管间质病变程度对预后有一定的影响
Objective: To investigate the tubulointerstitial lesions in patients with lupus nephritis (LN) and its clinical significance. Methods: According to the grade of tubulointerstitial lesions (TIL) score, 51 cases of LN patients were graded by renal biopsy and clinical data were used to observe the changes of tubulointerstitial damage and activity index (AI), chronic index ), Pathological type, proteinuria, renal function and other laboratory test results. Results: Forty-nine patients (96%) with tubulointerstitial lesions were found in 51 LN patients. The levels of AI, CI and TIL in patients with different grade of tubulointerstitial lesion grade LN were scored, the grade Ⅱ AI was the highest, and the difference was statistically significant compared with other grades (P0.05) Ⅲ grade score the highest, the difference was statistically significant (P <0.01, P <0.05). The degree of tubulointerstitial lesions in LN patients with pathological type Ⅳ was significantly higher than that in other pathological types. Correlation analysis showed that TIL was associated with the levels of AI, CI, Scr and Ccr in patients with LN, with r values of 0.373 (P <0.01), 0.813 (P <0.01), 0.396 <0.05), -0.476 (P <0.05), but no correlation with 24 h proteinuria. CONCLUSIONS: LN tubulointerstitial lesions have some correlation with pathological types, degree of renal dysfunction, activity index and degree of chronicity, suggesting that the degree of tubulointerstitial lesions has a certain impact on prognosis