| Background: Lupus nephritis(lupus nephritis,LN)is the most common complication of systemic lupus erythematosus(Systemic lupus erythematosus,SLE).Early diagnosis of renal lesions in patients with SLE,especially understanding the risk factors affecting the prognosis of LN,will certainly promote the improvement of the prognosis of SLE.Antiphospholipid antibodies(Antiphospholipid antibodies,aPLs)have been included in international guidelines as one of the diagnostic criteria of SLE.However,the results of domestic and foreign studies on the relationship between aPLs and SLE nephropathy are not consistent.Objective: In this study,the clinical manifestations,laboratory tests and related coexisting diseases of aPLs positive and negative LN patients were compared and analyzed in order to explore the effect of aPLs on renal lesions in LN patients.Methods: The clinical data of 195 patients with LN treated in the Department of Rheumatology and Immunology or the Department of Nephrology,Peking University Shenzhen Hospital from January 2008 to March 2020 were analyzed retrospectively,including laboratory examination,clinical manifestations,coexisting diseases,thrombosis,disease activity,renal pathological classification and activity index.According to the results of aPLs detection,patients with LN were divided into aPLs negative group and aPLs positive group.Statistical analysis was carried out by SPSS25.0.The counting data were analyzed by x2 test,continuity correction or Fisher exact probability method,and the measurement data were analyzed by t-testor Mann-Whitney rank sum test.Results:(1)General data: a total of 195 patients with LN were included,of which 63 were positive for aPLs,and the positive rate of aPLs was 32.3%.In the aPLs positive group,the percent of female for 93.7%,the percent of male was 6.3%,and the median age was 30(26,37)years old.In the aPLs negative group,the female accounted for 91.2%,the male accounted for 8.3%,and the median age was 32(27,37)years old.There was no significant difference in sex and age between the two groups(P>0.05).The time from the onset of initial symptoms to diagnosis in the aPLs positive group was 5(0.75,9.62)years,and that in the aPLs negative group was 2(0.01,7.17)years,the difference was statistically significant(P<0.05).(2)Clinical manifestations:the incidence of autoimmune hemolytic anemia(P=0.037)in the aPLs positive group was significantly higher than that in the negative group(P<0.05).There was no significant difference in fever(P=0.616),Raynaud phenomenon(P=0.487),arthritis(P=0.226)and other clinical manifestations between the two groups(P >0.05).(3)Laboratory examination showed that the levels of anti-double-stranded DNA antibody(P=0.043),creatinine(P=0.004),24-hour urinary protein(P=0.01)and serum Ig M(P=0.001)in aPLs positive group were significantly higher than those in negative group(P<0.05).The levels of serum albumin(P=0.01),C3(P=0.023)and CH50(P=0.019)in the negative group were significantly lower than those in the negative group(P<0.05).There was no significant difference in serum Ig A(P=0.399),serum Ig G(P=0.16)and serum C4(P=0.066)between the two groups(P >0.05).(4)Renal biopsy: renal biopsy was performed in 38 patients with LN,including19 patients with aPLs positive and 19 patients with aPLs negative.The chronic renal index of LN patients in aPLs positive group was higher than that in LN negative group,and the difference was statistically significant(P=0.034).There was no significant difference in renal pathological classification between the two groups(P > 0.05).Conclusion: The data in this study showed that compared with aPLs negative patients,LN patients with aPLs positive had shorter time from initial symptoms to diagnosis,significantly higher incidence of autoimmune hemolytic anemia,severe renal lesions and higher chronic index.Our results suggest that routine detection for aPLs is necessary in patients with LN,and aPLs positive patients need to be treated and follow-up strictly. |
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