摘要
目的分析抗磷脂综合征(APS)致肾损害的临床特点,旨在提高对该类疾病的认识。方法回顾性分析北京协和医院1983年至2004年期间91例APS中肾损害的临床特点及其中8例的肾组织学表现。结果原发性APS(PAPS)13例(14.3%);继发性APS(SAPS)78例(85.7%),其中系统性红斑狼疮(SLE)55例(占SAPS的70.5%)。APS伴肾损害共82例(90.1%),男性20例、女性62例;PAPS肾损害发生率为76.9%,SAPS为92.3%;发生肾损害时年龄为(38±14)岁,肾损害前病程为(4.9±6.8)年。肾损害临床表现主要为蛋白尿(92.7%)、肉眼血尿(2.4%)、镜下血尿(76.8%)、高血压(33.0%)、肾功能不全(18.3%),其中12.2%为肾病综合征。14例(15.4%)出现急性肾功能不全,病因包括血栓性微血管病、肾动脉栓塞、肾静脉血栓形成等。肾组织学检查8例,均为SLE所致PAPS,APS肾病占62.5%,表现为肾小血管、肾小球毛细血管血栓形成以及肾小叶间动脉内膜增生、洋葱皮样改变。结论APS肾损害比较常见,临床上以蛋白尿最为多见,可伴血尿、高血压,可引起血栓性微血管病、肾动脉栓塞或肾静脉血栓形成,致肾功能急剧恶化。
Objective To analyze the clinical characteristics of renal involvement associated with antiphospholipid syndrome (APS). Methods Data of 91 cases with APS who were admitted to our hospital from 1983 to 2004 were reviewed. Results Thirteen cases (14.3%) were primary APS (PAPS) and 78 cases (85.7%) were secondary APS(SAPS) including 55 cases with systemic lupus erythematosus. Renal involvement were found in 82 APS cases (90.1%). 76.9% patients with PAPS and 92.3% with SAPS had renal involvement. The average age of renal involvement was (38±14) years old. The ratio of male to female was 1:3.1 and the period of pre-renal damage was (4.9 ±6.8) years. The clinical manifestations included proteinuria (92.7%), gross hematuria (2.4%), microscopic hematuria (76.8%), hypertension (33.0%) and renal insufficiency(18.3%). Fourteen cases (15.4%)of acute renal insufficiency were caused by thrombotic microangiopathy, renal artery thrombosis, renal vein thrombosis and others. Kidney biopsy specimens were obtained from 8 patients with SLE,among them,5 (62.5%)had APS nephropathy and exhibited thrombosis of renal capillaries and renal small vessels, and fibrous intimal hyperplasia of renal interlobular arteries. Onion-peeled renal interlobular arteries were also found. Concolusions Renal involvements in APS are quite common, mainly including proteinuria, hematuria and hypertension. Thrombotic microangiopathy, renal artery thrombosis, renal vein thrombosis may occur and progress to acute renal insufficiency.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2005年第6期320-323,共4页
Chinese Journal of Nephrology
