| ObjectiveThrough the retrospective analysis of clinical data and pathological data of 257 cases of lupus nephritis(LN),we analyzed the clinical characteristics of LN,and to explore the correlation between clinical score and pathological score,aiming to provide reference for the non-invasive evaluation of renal pathological activity in patients with LN.Methods257 patients diagnosed as SLE in nephrology department of our hospital from January 2008 to December 2017 were selected as research subjects,and each patient underwent renal biopsy in accordance with the diagnsis of LN.Clinical manifestations,laboratory examinations,and pathological data of patients with LN were analyzed to analyze the clinical features of LN.At the same time,each patient was subjected to three clinical scores,which were Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)2000,British Isles Lupus Assessment Group Index(BILAG)2004 and Lupus Activity Assay(SLAM).The pathological type was performed according to the International Society for Kidney Diseases/Internal Renal Pathology(ISN/RPS)2003 classification criteria for LN,and each patient was subjected to activity index(Acute Index,AI),chronic index(Chronic Index,CI)and intertubular lesion(Tubulointerstitial lesions,TIL),investigating the correlation between three clinical scores and pathological score.Results1.The distribution of gender and age: Among 257 patients with LN,29 cases(11.28%)were male,and the average age was 36.10±15.53 years old.228 cases(8.72%)were females,and the average age was 36.57±13.34 years old.The ratio between men and women is 1:7.86.The incidence of male patients with LN was slightly lower than that of females(p>0.05).2.The distribution of pathological types : Among 257 patients with LN,type IV was the most common among the pathological types(79 cases,30.74%),followed by type IV+V(70 cases,27.24%),type I is rare(2 cases,0.78%),type Ⅵ was zero.3.Clinical manifestations of extrarenal injury:The incidence of hematologic injury was the most common(207 cases,80.55%),followed by rash(134 cases,52.14%),Serositis(133 cases,51.75%),joint pain(111 cases,43.19%).The incidence of central nervous system injury was the most rare(11 cases,4.28%).The incidence of hematologic injury in type IV was the highest(91.14%),and the incidence of type II was significantly lower than those of type III,type IV,type III + V and type IV + V(p<0.05),and the incidence of type V was significantly lower than that of type IV(p<0.05).4.Clinical classification of renal injury:Nephrotic syndrome was the most common(95 cases,36.97%),followed by nephritis syndrome(69cases,26.85%)and renal insufficiency(67cases,26.06%),and latent nephritis was the least(26 cases,10.12%).Latent nephritis was mainly seen in type II(38.46%),and nephritis syndrome was mainly seen in type II(46.15%),type III(40.74%)and type Ⅴ(41.86%),and nephrotic syndrome was mainly seen in type IV(39.24%),type III + V(43.47%)and type IV + V(45.71%),and renal insufficiency was mainly seen in type Ⅳ(35.44%)and type Ⅳ+Ⅴ(35.71%).5.Laboratory examination:The incidence of anaemia in type IV was highest,Its ratio is up to 89.87%.type III,type IV,type III+V and type IV+V was significantly higher than those of type II and type V(p<0.05).The incidence of microscopic hematuriain in type IV was significantly higher than those of type II,types III and V(p<0.05),and type IV+V was significantly higher than those of Type II and type V(p<0.05).The hemoglobin of type II was significantly lower than type IV,type III+V and type IV+V(p < 0.05).The incidence of elevated serum creatinine in type IV and type IV+V was significantly higher than those in type II,and V(p <0.05).The incidence of elevated serum uric acid in type IV and IV+V was significantly higher than those of type II,type III and type V(p<0.05).The level of 24-hour urinary protein in type II was significantly lower than other pathological types(p<0.05),and type IV+V was significantly higher type II,type III and type V(p<0.05).6.Clinical score: The score of SLEDAI2000,BILAG2004 and SLAM were the highest in type IV,which were 18.61 + 4.40,15.49 + 3.61 and 11.43±2.86 respectively.The second high was type IV + V,which were 17.01±4.04,14.03±3.05 and 9.76±3.53 respectively.The score of SLEDAI2000 and SLAM in type II were significantly lower than those of type III and type IV,type III + IV and V + V(p<0.05),and type V was significantly lower than those of type IV and IV + V(p<0.05).The score of BILAG2004 in type II and type V was significantly lower than those of type IV,type III + IV + V and type V(p<0.05),and type III was significantly lower than those of type IV and IV + V(p<0.05).7.Pathological score:The score of AI,CI and TIL in type IV were highest,which were 7.41±2.36,4.56±2.42 and 4.86±2.37 respectively.The second high was type IV + V,which were 6.96±2.32,3.34±1.30 and 4.26±1.93 respectively.The score of AI in type IV and IV+V were significantly higher than other pathological types(p<0.05)and type III+V was significantly higher in type II and type V(p<0.05).The score of CI in type IV were significantly higher than type II,type III,type V and type III+V(p<0.01).The score of TIL in type IV were significantly higher than type II,type III and type V(p<0.01),and type IV +V was significantly higher than type II(p<0.05).8.Correlation analysis between clinical score and pathological score:(1)The score of BILAG2004,SLEDAI2000 and SLAM in type II,type III,type IV,type III+V and type IV+V were positively correlated with AI(0<r<1,p< 0.05),and the score of BILAG2004 and SLEDAI2000 in type V were positively correlated with AI(0<r<1,p<0.05).(2)The best correlative pathological type between SLEDAI2000 score and AI was type II,followed by type III.The best correlative pathological type between BILAG2004 score and AI was type IV+V,followed by type II.The best correlative pathological type between SLAM 2000 score and AI was type II,followed by type III+V.(3)The correlation between BILAG2004 score and AI was better than that of SLEDAI2000 and SLAM.(4)There was no significant correlation between BILAG2004,SLEDAI2000 and SLAM scores with CI and TIL(p<0.05).ConclusionOur single-center retrospective analysis shows:(1)The pathological type of LN was most common in type IV,followed by type IV+V.The most common clinical type of LN was Nephrotic syndrome,followed by nephritic syndrome.(2)BILAG2004,SLEDAI2000 and SLAM score were positively correlated with AI(0<r<1,p< 0.05),and it could be used to assess the degree of activity of LN.(3)The correlation between BILAG2004 score and AI was better than that of SLEDAI2000 and SLAM,and it could better guide the diagnosis,treatment and evaluation of the prognosis. |
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