| Objective This study aims to explore the early dignosis of SLE patients with renaldamage as the initial Clinical Manifestation through the contrast of clinical andpathological features between the cases renal damage starting and non-renal damagestarting.Methods Retrospective survey437patients clearly diagnosed with systemic lupuserythematosus and hospitalized in The second affiliated hospital of Jilin university duringJanuary2009to December2014,143cases starting with renal damage as the researchobject, and294cases non-renal damage starting as the control group, which included115cases of skin damage starting,63cases of Joint muscle damage starting,42cases startingthe blood system damage,52cases starting with fever,7cases starting with heart damage,6patients starting with respiratory damage,6patients starting with nervous systemdamage,3cases starting with the digestive system damage. Their case data are recordedin detail,which included gender, age, disease activity score, clinical symptoms,laboratory indexes including conventional laboratory tests and immunological indexes,and pathology results of175patients who underwent renal puncture from group startingwith renal damage81cases and group starting with non-renal damage94cases. Thendrew a conclusion by statistical analysis.Results1)SLE patients have obvious gender tendency with the proportion of1:8.71between men and women. Men aged from13to84years old (39.01±17.091)and womenfrom7to80(38.08±14.23)are susceptible to SLE.2) according to activeity index(SLEDAI score), group starting with renal damage is mainly on severe active diseaseand the least percentage of inactive;3) group starting with renal damage tends to mergeblood system damage, joint muscle damage, loss of hair, skin lesions, etc. the mainclinical diagnosis before certain SLE or LN diagnosed are nephrotic syndrome, chronicnephritis, proteinuria, chronic renal failure, acute kidney injury, etc.,main department first diagnosed is nephrology;4) the positive rate of renal damage related laboratoryinvestigation in group starting with renal damage is higher than non-group starting withrenal damage;5) immunological investigation:the rate of increased IgG and CRP ingroup starting with renal damage is less than that non-group starting with renal damage,but the rate of reduced C4is higher than that in non-group starting with renal damage.6)auto-antibodies investigation: positive rate of SSA antibody in the kidney involvementgroups are higher than the kidney spared group,respective P is0.024<0.05and0.006<0.01with statistical significance; the positive rate of dsDNA antibody in group notstarting with renal damage(76.44%) is significantly higher than in group starting withrenal damage (62.43%) and kidney spared group (37.70%)(respective P is0.009and0<0.01), with statistical significance. Postive rate of anti-dsDNA is higher than AnuA ingroup with renal damage. The positive rates of auto-antibodies againstdsDNA,U1RNP,histones,Sm,SSB,ribosomal p protein and nucleolus had no significantdifferences between groups.7) the pathological type of group starting with renal damageand no-group starting with renal damage is mainly class Ⅳ and calss Ⅳ/Ⅴ and theratio of class Ⅳ in group starting with renal damage is higher than that in groupstarting with non-renal damage, the ratio of class Ⅱ LN is lower than non-groupstarting with renal damage with statistical significance.8)class Ⅲ LN patients is mainlycharacterized by chronic nephritis and patients of type Ⅳ,Ⅴ, Ⅲ/Ⅴ and Ⅳ/Ⅴ aremainly nephrotic syndrome.9) All pathological classes LN in group starting with renaldamage tended to merge the blood system damage.Conclusion:1)renal damage are common with SLE patients and usually are the startingperformance;2) dsDNA antibody is pecific and more sensitive than ANuA for renalinvolvement in SLE patients;3) renal pathology classes of LN patients is mainly classⅣ,class Ⅳ/Ⅴ;4) pathology of SLE patients with different clinical renal damage showtypical LN histological changes. |
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