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目的:观察以肾脏损害为主要临床表现而不能明确诊断或被误诊为其他肾脏疾病的系统性红斑狼疮(systemic lupusery the matosus,SLE)患者的早期临床表现及其肾活检病理分型,分析可能存在的相互关系,探讨以狼疮性肾炎(lupus nephritis,LN)为主要临床表现的不典型SLE患者的早期诊断。方法:选取31例首发症状为肾脏损害,肾活检病理检查确诊为SLE住院患者,观察其早期的临床症状、病理类型,综合分析两者间的相互关系。结果:31例患者中临床表现为急进性肾炎1例,急性肾炎1例,慢性肾功能衰竭2例,慢性肾炎11例,肾病综合征16例;肾活检病理结果显示:Ⅰ型1例(3.23%),Ⅱ型4例(12.9%),Ⅲ型5例(16.13%),Ⅳ型10例(32.3%),Ⅴ型9例(29.0%),Ⅵ型2例(6.45%);肾脏病理分型中Ⅳ、Ⅴ型所占比例最多表现为肾病综合征;以慢性肾炎为主要临床表现的为Ⅱ、Ⅲ型。结论:SLE临床表现与肾脏病理分型之间存在相关性;肾活检对SLE早期的诊断与治疗有着积极的指导作用,并且为疗效及预后的评估提供了重要的理论依据。
OBJECTIVE: To observe the early clinical manifestations and pathological classification of renal biopsy in patients with systemic lupus erythematosus (SLE), whose main clinical manifestation is renal impairment, which can not be definitely diagnosed or misdiagnosed as other kidney disease. To investigate the early diagnosis of atypical SLE patients with lupus nephritis (LN) as the main clinical manifestations. Methods: Thirty-one patients with primary lesion were selected as renal lesion and the pathological examination of renal biopsy was performed as SLE inpatients. The clinical symptoms and pathological types of the patients were observed. The relationship between them was analyzed comprehensively. Results: The clinical manifestations were as follows: 1 case of acute nephritis, 1 case of acute nephritis, 2 cases of chronic renal failure, 11 cases of chronic glomerulonephritis and 16 cases of nephrotic syndrome. The pathological results of renal biopsy showed that type Ⅰ 1 (3.23 (12.9%) in type Ⅱ, 5 (16.13%) in type Ⅲ, 10 (32.3%) in type Ⅳ, 9 (29.0%) in type V and 2 cases (6.45% Type Ⅳ, Ⅴ most represented as the proportion of nephrotic syndrome; chronic nephritis as the main clinical manifestations of type Ⅱ, Ⅲ. CONCLUSIONS: There is a correlation between the clinical manifestations of SLE and the pathological type of renal pathology. Kidney biopsy has a positive guiding role in the early diagnosis and treatment of SLE, and provides an important theoretical basis for the evaluation of curative effect and prognosis.