摘要
目的结合肾活检、相关实验室检测结果及随访情况,进一步探讨干燥综合征(SS)肾脏损害的临床病理及预后。方法对我科1993—2004年收治的147例SS肾脏损害患者,进行常规免疫学、肾小管功能及部分肾活检检查。结果原发和继发性SS中分别有67/103例和19/44例表现为肾小管酸中毒,各有3/103例和2/44例合并肾性尿崩症,共10例合并低钾性麻痹;原发性SS中15/103例以肾小球病变为主;22/103例原发性SS和8/44例继发性SS患者就诊时有肾功能不全;明显高酌球蛋白血症存在于68.9%的原发性SS和61.4%的继发性SS患者中。肾活检组织检查56例,光镜下30例原发性SS中,20例为慢性间质性肾炎伴肾间质中大量淋巴细胞和浆细胞浸润及小管不同程度萎缩,免疫荧光检查大多阴性,部分标本肾小球有免疫球蛋白和补体沉积,1例肾间质细胞内IgG阳性。6例继发性SS皆为狼疮肾炎。103例原发性SS中,74例用激素或激素加免疫抑制剂治疗,肾功能恢复正常12例,44例继发性SS按原发病治疗,5例肾功能恢复正常。结论SS肾脏损害常见,以肾小管性酸中毒和肾小球肾炎为主要表现,必要的激素、免疫抑制剂治疗可明显改善肾功能。
Objective To understand the impact of Sj gren′s syndrome (SS) on kidney by following up 147 patients with Sj¨o gren′s syndrome between 1993-2004. Methods One hundred forty-seven patients of SS with renal impairment between 1993-2004 were analyzed by routine, immunoassay, tubular function and renal biopsy examination. Results Among 147 SS patients, 103 were diagnosed as primary SS, while 44 were diagnosed as secondary SS. Sixty-seven of primary SS and 19 of secondary SS presented with renal tubular acidosis (RTA); while 3 primary SS and 2 secondary SS developed diabetes insipidus. In addition, 10 cases of either primary or secondary SS had hypokalemic paralysis. Among primary SS, 15 patients presented with glomerulonephritis. Twenty-two patients with primary SS and 8 patients with secondary SS initially presented with renal impairment. Significant elevation of IgG was noticed among 68.9% of primary SS and 61.4% of secondary SS, renal biopsy of 56 patients showed 20 of 30 primary SS had chronic interstitial nephritis with large amount of lymphocytes and plasma cells infiltration and variable atroph of renal tubule under light microscope. Most of the immunofluorescence results were negative, only a few samples showed positive immunoglobulines and complements. One case of renal biopsy showed positive stain of IgG in the interstitial. Six cases of secondary SS were consistent with lupus nephritis. Among 103 primary SS, 74 patients responded to the combination of steroid and immunosuppressors, and 12 had renal function completely recovered. On the other hand, among those 44 secondary SS treated for their primary lesions, five had their renal function recovered. Conclusions Patients with Sj¨o gren′s syndrome are commonly associated with renal impairment, mainly tubular acidosis and glomerulonephritis. The combination of steroid and immunosuppressors can significantly improve the renal function of patients with Sj¨ogren′s syndromes.
出处
《中华风湿病学杂志》
CAS
CSCD
2005年第6期351-353,共3页
Chinese Journal of Rheumatology
