| Objectives:To understand the clinical characteristics of common pathological types of lupus nephritis,such as Ⅲ,Ⅲ+Ⅴ,Ⅳ,IV+V and V,as well as the therapeutic effect of different pathological types,and to explore the relationship between different pathological types and clinical efficacy,so as to provide basis for clinical diagnosis,treatment and efficacy evaluation.Methods:80 patients cases collected from April 2013 to April 2020 in yan ’an hospital affiliated to kunming medical university nephropathy subject hospital,according to the American rheumatism association in 1997 SLE classification standard combined with clinical diagnosis of systemic lupus erythematosus(SLE),with lupus nephritis(LN),and clear after renal biopsy diagnosed with lupus nephritis type III,typeⅢ+V,typeⅣ,ypeⅣ+Ⅴ and typeV,grouped according to pathological types.Type Ⅰ,type Ⅱ,type Ⅵ with fewer pathological types and types associated with other connective tissue diseases were excluded.Collect the patient’s general condition,clinical manifestation,pathological data and laboratory related auxiliary examination,the curative effect of 3 months after treatment and other related data,were analyzed retrospectively study.To explore the relationship between the clinical characteristics of different pathologic types of lupus nephritis,laboratory related tests,and the efficacy of the same treatment regimen 3 months after treatment.laboratory related auxiliary examination,clinical treatment and 3 months after treatment the curative effect of the relationship between.SPSS 24.0 software was used for statistical analysis of relevant data.Results:(1)General information:Of the 80 patients enrolled who were diagnosed withlupus nephritis,the male-to-female ratio was approximately 1:8.The age of onset ranged from 14 to 55 years,with an average age of 32.34± 11.8 years.The incidence rate of patients aged 20-40 years is high(56.25%),which tends to occur in women of childbearing age over 20 years old.As shown in Table 1,there were no statistically significant differences between the male and female distribution ratios and age distribution among different pathological types of LN(P>0.05),so it can be considered that the male and female distribution ratios and age distribution ratios were balanced between groups.The course of disease of LN patients was different between groups,P<0.05,indicating that the difference was statistically significant.(2)Distribution of pathological types:Among the 80 patients diagnosed with lupus nephritis by renal biopsy,the highest proportion was type IV+V 40%,followed by type IV 28.75%,type Ⅲ 12.5%,type Ⅲ+Ⅳ 12.5%,and the least was type Ⅲ 6.25%.In this study,lupus nephritis of type Ⅰ,type Ⅱ and type Ⅵ with few cases were not included.(3)Clinical features of LN:facial erythema,arthritis,hair loss,muscle pain,edema,and renal insufficiency are different in the distribution of LN in different pathological types,P<0.05,the difference was statistically significant.However,hypertension,photohypersensitivity,oral ulcer,Raynaud’s phenomenon,leukopenia,fever,Sjogren’s syndrome,anemia,proteinuria,microscopic hematuria,lupus encephalopathy,and neuropathy showed no statistically significant differences among the pathological types(P>0.05).Laboratory general data,immunization data,AI,CI,SLEDAI analysis:Before treatment,there were differences in 24-hour urinary protein(24-UP)between different pathological types,P<0.05,the difference was statistically significant,and the 24-hour urinary protein of type Ⅳ+Ⅴwas higher than those of type Ⅲ and type Ⅲ+Ⅴ.After treatment,24-UP of type Ⅲ,Ⅳ,Ⅴ and Ⅳ+Ⅴ significantly decreased compared with that before treatment,P<0,05,the difference was statistically significant.There was no significant difference in typeⅢ+Ⅴ compared with before treatment,P>0.05,the difference was not statistically significant.There were statistically significant differences in serum creatinine levels between groups before and after treatment(P<0.05).Before treatment,serum creatinine levels of type Ⅳ and Ⅳ+Ⅴ were higher than those of type V andⅢ+Ⅴ.After treatment,type Ⅳ had higher serum creatinine levels than type Ⅲ,Ⅴ,andⅢ+Ⅴ,P<0.05,the difference was statistically significant.Serum creatinine of typeⅣ+Ⅴ decreased significantly after treatment compared with before treatment(P<0.05),the difference was statistically significant.There were differences in serum albumin between groups before treatment,P<0.05,the difference was statistically significant.Serum albumin of Type Ⅲ was higher than Ⅳ+Ⅴ and Ⅴ,and serum albumin of type Ⅳ was higher than Ⅳ+Ⅴ.Albumin increased significantly after treatment in five groups compared with before treatment,P<0.05,the difference was statistically significant.There were differences in endogenous creatinine clearance between groups before and after treatment,P<0.05,the difference was statistically significant.Before treatment,the endogenous creatinine clearance rates of type Ⅳ andⅣ-Ⅴ were lower than those of type V and Ⅲ+Ⅴ,and that of type Ⅳ was lower than that of type Ⅲ.After treatment,the endogenous creatinine clearance of type Ⅳ andⅣ+Ⅴ was lower than that of type Ⅲ and Ⅴ,and type Ⅳ was lower than that of typeⅢ+Ⅴ,P<0.05,the difference was statistically significant.There were differences among urea nitrogen,fibrinogen,urinary red blood cells,urinary white blood cells,complement C3 and complement C4 groups,P<0.05,the difference was statistically significant.There were differences in urea nitrogen,fibrinogen,urinary red blood cells,urinary white blood cells,complement C3 and complement C4,hemoglobin,uric acid,albumin globulin ratio,after treatment and before treatment,P<0.05,the difference was statistically significant.There were differences in rRNP and SM between groups before and after treatment,P<0.05,and the differences were statistically significant.White blood cell,platelet,total cholesterol,triglyceride,low density lipoprotein,IgM,pathological tube type,SSA and anti-DS-DNA antibody showed no statistically significant difference among LN pathological types(P>0.05).There were statistically significant differences in SLEDAI scores between groups before and after treatment(P<0.05).SLEDAI score of type Ⅳ was the highest,V was the lowest.After treatment the SLEDAI score of the five groups was significantly lower than that before treatment,P<0.05,the difference was statistically significant.The activity index difference between groups was statistically significant(P<0.05),type IV+V had the highest AI,followed by type Ⅳ P<0.05,the difference was statistically significant.(5)Relationship between relevant indicators and 24-UP after 3 months of treatment:1)There was no significant difference in 24-UP after 3 months between the group treated with RASS inhibitor and the group not treated with RASS inhibitor,P>0.05,the difference was not statistically significant.2)After treatment three months later,24-UP in the group without renal insufficiency was significantly lower than that in the group without renal insufficiency,P<0.05,the difference was statistically significant.(6)Efficacy analysis:Lupus nephritis patients treated with methylprednisolone or methylprednisolone combined with immunosuppressive agents:the overall response rate of type Ⅲ was 100%,type Ⅳ had an overall effective rate of 65.2%,the overall efficiency of V-type is 60%,the overall effective rate of Ⅲ+Ⅴ type is 60%;the overall effective rate of Ⅳ+Ⅴ is 46.9%.The overall efficiency of type Ⅲ and Ⅳ+Ⅴ was different,P=0.0498,P<0.05,the difference was statistically significant.Pairwise comparisons between the other groups showed no statistically significant difference(P>0.05).Conclusions:1.The highest proportion of lupus nephritis pathological types was typeⅣ+Ⅴ,followed by type Ⅳ.Type Ⅳ+Ⅴ lupus nephritis had the highest pathologic activity index,followed by type Ⅴ.2.Glucocorticoid combined with cyclophosphamide is suitable for lupus nephritis type Ⅲ,type Ⅲ+Ⅴ,type Ⅳ,type Ⅳ+Ⅴ and type Ⅴ.3.After treatment with glucocorticoid combined with cyclophosphamide for 3 months,the overall remission rates of all pathologic types in the study of lupus nephritis patients were increased,suggesting that the curative effect of type Ⅲ was significant,whil the effect of type Ⅳ+Ⅴ was poor. |
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