| Objective:A comprehensive analysis of the relationship between pathological types,clinical manifestations and laboratory indexes of 89 cases with lupus nephritis,to provide some help for the diagnosis of some patients with atypical LN or contraindications and unwilling to undergo renal biopsy.Methods:A retrospective study from January 2014 to December 2019,89 cases(renal biopsy for the first time and diagnosed LN)in the department of nephrology of the second department of the first hospital of jilin university.The study analyzed the relationship between pathological,clinical manifestations,and laboratory indicators.Use Microsoft Excel software to establish data tables.SPSS 22.0 software was used for statistical analysis of data.The measurement data of normal or approximate normal distribution were expressed as((?)±s),t-test was used between the two groups,and analysis of variance was used between the groups.Measurement data of skewed distribution were represented by median(lower quartile-upper quartile),and rank sum test was used.Counting data are expressed by frequency or percentage and chi-square test is used.Using Perason or Spearman correlation analysis,P< 0.05 was statistically significant,and P<0.01 was statistically significant.Results:1.Clinical data: In 89 cases with lupus nephritis,80 females(89.9%)and 9males(10.1%),female patients were significantly more than male patients,the ratio of male to female being 1:8.8.The average age of the first clinical symptoms was38.64±12.09 years old,and the average age of the first kidney biopsy was40.34±11.94 years old.Female patients were significantly more than male patients,but there was no significant difference between male and female patients in each pathological type(P>0.05).2.Pathological data: The renal pathological types of 89 cases with renal biopsy were? type in 5 cases(5.6%),type ? in 14 cases(15.7%),type ? in 56cases(62.9%),type ? in 14 cases(15.7%)? Renal pathological types are mainly manifested as ? type.3.Clinical classification : Nephritis syndrome(33.7%)is the most common clinical classification in 89 case,renal insufficiency(32.6%)of the second,again(31.7%)nephrotic syndrome,2 cases of latent nephritis(2.2%).The difference of clinical typing in different pathological types of LN was statistically significant(P<0.05).Nephritis syndrome type was commonly observed in ? type,and Nephrotic syndrome has the highest incidence of ?type,renal insufficiency type is common in? type.4.Extra-renal clinical manifestations: renal outward manifestations of 89 patients with lupus nephritis: 20 patients with fever(22.5%),lack of power 15 cases(16.9%),morning stiffness in 5 cases(5.6%),light allergic 7 cases(7.9%),arthritis,39cases(43.8%),4 cases of oral cavity ulcer(4.5%),23 cases of hair loss(25.8%),high blood pressure,22 cases(24.7%),4 cases of Renault syndrome(4.5%),butterfly erythema of 31 cases(34.8%),serositis 51 cases(57.3),blood system change in 62cases(69.7%);Only 1 of the 89 patients was definitely diagnosed with lupus nervous system changes.There was no statistically significant difference between different pathological types of LN in fever,fatigue,oral ulcer,hair loss,hypertension,etc.(P>0.05),and there was statistically significant difference between raynaud's syndrome and butterfly erythra(P<0.05).5.Relationship between different LN pathological type and laboratory indexes:The hemoglobin(HB),albumin(ALB)and Serum creatinine(Scr)in LN of different pathological type between the difference was statistically significant(P < 0.05),?type and ? type in difference of hemoglobin(HB)is significant(P < 0.05);Albumin(ALB)in the different between ? type and ?type,?type,?type was statisticallysignificant(P < 0.05),?type,?type and?type of albumin(ALB)was less ? type than low;The different of Serum creatinine(Scr)between ? type,? type and ?type was statistically significant(P < 0.05),? type of Serum creatinine(Scr)was higher than ? type and ?type.In 89 cases of LN have 56 patients(62.9%)of anemia,mild anemia(110/120 90-g/L)in 35 cases(39.3%),moderate anemia(60-90-g/L)in 18cases(20.2%),severe anemia(< 60 g/L)in 3 cases(3.4%),mild anemia and moderate anemia were common in 89 cases of LN.mild anemia and moderate anemia are common in ?type and?type.All 89 cases of LN had proteinuria,mild proteinuria(<0.5 g / 24 h)in 5 cases(5.6%),moderate proteinuria(0.5to 3.5 g / 24 h)in 38 cases(42.7%),severe proteinuria(> 3.5 g / 24 h)in 46 cases(51.7%),severe proteinuria is the most common in 89 cases patients,but severe proteinuria is more common in ?type than in others type.Serum creatinine(Scr)was significant negatively correlated with hemoglobin(HB)and red blood cell count(RBC)(P<0.01).Serum creatinine(Scr)was negatively correlated with platelet(platelet)(P<0.05).Serum creatinine(Scr)was significant positively correlated with Uric acid(Ur)(P<0.01).6.Relationship between different pathological types of LN and immunological indexes: ANA,anti-dsdna antibody,anti-sm antibody,anti-u1 rnp antibody and other immunological indexes in LN of different pathological type between the difference was no statistically significant(P>0.05).But,in all immunological indexes,ANA,anti-dsdna antibody,anti-sm antibody and anti-u1 rnp antibody had higher positive rates in LN.The anti-SSA antibody difference was statistically significant in the different pathological type(P < 0.05),the difference is particularly striking between?type and ? type(P < 0.05).The decrease rates of C3 and C4 in 89 patients with LN were higher,reaching 94.4% and 66.3%,respectively,but there was no statistically significant difference between different pathological types of LN in C3 and C4(P>0.05).7.Analysis of clinical disease activity and renal pathologic activity of patients with LN: There was no statistically significant difference between the pathological types of LN in the score of SLEDAI(P>0.05).But the difference between AI and CI scores of each pathological type was statistically significant(P<0.05).The findings ofline phase relation analysis:AI,CI and SLEDAI scores were significantly positively correlated(P<0.001).However,C3 was negatively correlated with SLEDAI score(P<0.05).Conclusion:1.There are more female patients than male patients in LN patients.2.LN the most common pathological types in ? type,clinical manifestations and pathological organization activities often than other type heavy,it is worth the attention of clinicians.3.LN patients in immunological indexes ? type anti dsDNA positive higher than that of other types,anti dsDNA ? type were the lowest.4.Scr was negatively correlated with RBC,HB and PLT,and positively correlated with Ur in LN patients.SLEDAI score was positively correlated with AI and CI,and negatively correlated with C3.5.There was a certain relationship between clinical manifestations,laboratory indexes and pathology of different LN.In clinical practice,patients with atypical LN,contraindications or unwilling to undergo renal biopsy can be used to determine the severity of the disease and guide treatment. |
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