摘要
目的探讨儿童SLE的临床和实验室指标特点及狼疮性肾炎(LN)的肾脏病理类型。方法选取2001年1月-2011年1月本院住院确诊的SLE患儿100例,其中LN 82例,分析其临床表现、实验室和病理检查资料,应用SAS 9.1软件对SLE及各病理类型LN按临床及实验室检查特点行χ2检验。结果 100例SLE患儿,男19例,女81例;发病年龄(10.28±2.98)岁。发病高峰为9～14岁的女性患儿。新生儿1例。临床表现以发热(54%)、皮肤损害(54%)最常见,其次为水肿(34%)、关节炎(22%)、肝脾大(18%)、淋巴结大(15%)、口腔溃疡(4%)。SLE患儿的肾脏累及率为82%。其中肾炎性肾病占33%;血液系统累及率较高,其中贫血59%、低清蛋白血症53%、血小板降低20%;呼吸系统感染40%,肝损害26%,中枢神经受累16%,浆膜炎13%。免疫学检查血清ANA阳性(82%)、补体C4降低(77%)、补体C3降低(70%)、ESR加快(59%)、dsDNA阳性(52%)。48例肾活检病例均有病理异常,病理类型以Ⅳ型最多,占27%;肾脏累及和无肾脏累及组患儿在补体C3降低(P=0.040 9)、抗dsDNA阳性(P=0.023 0)、水肿(P=0.023 6)方面比较差异均有统计学意义。将48例肾活检病例分为增殖性和非增殖性肾炎2组,对Ⅲ、Ⅳ、Ⅴ型+Ⅲ型和Ⅴ型+Ⅳ型(增殖性病变)和Ⅰ、Ⅱ和Ⅴ型(非增殖性病变)进行统计学分析,发现补体C3降低(P=0.042)、抗ANA阳性(P=0.000 6)、ESR加快(P=0.021 9)、贫血(P=0.003 8)差异有统计学意义。结论儿童SLE肾脏、血液系统及呼吸系统累及率最高。补体C3降低、dsDNA阳性和首发表现为水肿的SLE患儿可能更易累及肾脏。肾脏病理表现为增殖性病变的患儿更易发生贫血,补体C3降低、抗ANA阳性、ESR加快提示增殖性病变处于活动期。
Objective To explore the clinical and laboratory data of children with systemic lupus erythematosus（SLE） and histopathological features of lupus nephritis（LN）. Methods Patient records between Jan.2001 to Jan.2011 were retrospectively derived from the Children′s Hospital Affiliated to Shanghai Jiaotong University.The clinical and laboratory data of 100 cases of SLE in childhood（of them,82 had LN）were retrospectively analyzed.One-way analysis of chi-square test were employed to compare the differences between the groups.All analyses were performed by using the SAS 9.1 software. Results Of the 100 cases of SLE,19 were male and 81 were female,and the mean age was（10.28 ±2.98） years old.The incidence of female patients between 9 and 14 years was the top,and 1 case was neonate.Most patients showed some clinical manifestation in kidney disease（82%）,and nephrosonephritis was the most common clinical feature（33%）,most of the patients had class the Ⅳ LN（27%）.In these patients,the incidence of fever was 54%,skin lesion was 54%,the others were： edema（34%）,arthritis（22%）,hepatosplenomega（18%）,lymphadenectasis（15%）,oral ulcer（4%）.Hematologic system cumulative percentage was high,anemia（59%）,hypoalbuminema（53%）,thrombocytopenia（20%）.The respiratory infection（40%） was the most common complication,the others were： hepatic involvement（26%）,central nervous system（16%）,serositis（13%）.Immune indexes：decreased C3 complement（70%）,decreased C4 complement（77%）,ESR（59%）,ANA（82%）,dsDNA（52%）.While the patients with SLE（non-LN）and LN classes showed significant differences in decreased C3 complement（P=0.040 9）,dsDNA（P=0.023 0）,edema（P=0.023 6）.Forty-eight patients（renal biopsies） were classified into two classes： DPGN（type Ⅲ,Ⅳ,Ⅴ＋type Ⅲ,type Ⅴ＋type Ⅳ）,non-DPGN（type Ⅰ,Ⅱ,Ⅴ）.There were significant differences in decreased C3 complement（P=0.041 6）,ANA（P=0.000 6）,increased ESR（P=0.021 9）,anemia（P=0.003 8） between these 2 groups. Conclusions Kidney disease,respiratory system and the blood system are involved as he highest rate in childhood SLE with decreased C3 complement,dsDNA,edema may be more easy to develop LN,and DPGN patients have more chances to produce complications such as anemia.Decreased C3 complement,ANA positive,increased ESR also indicate that DPGN stay active stage in the whole disease progress.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2012年第21期1660-1662,共3页
Journal of Applied Clinical Pediatrics
关键词
系统性红斑狼疮
狼疮性肾炎
儿童
systemic lupus erythematosus
lupus nephritis
child
