【摘要】 目的 发现提示早期Ⅴ型狼疮性肾炎（lupus nephritis，LN）的指标。 方法 2004年 1月-2009年11月24例经肾活检诊断为Ⅴ型LN患者，与同期50例膜性肾病伴抗核抗体（antinuclear antibody，ANA）阳性患者、50例膜性肾病ANA阴性患者，以及13例膜性肾病ANA阳性且肾组织荧光为“满堂亮”患者的一般资料、肾病表现、肾脏病理以及实验室指标进行比较。 结果 Ⅴ型LN与膜性肾病ANA阴性的患者相比，两组的性别、起病年龄、血红蛋白、补体水平、内皮和系膜增殖的比例等有明显差异。膜性肾病ANA阳性患者的临床和病理表现更接近于ANA阴性的膜性肾病，但其性别比仍以女性居多。而膜性肾病ANA阳性伴“满堂亮”的患者在性别、肾病表现、血红蛋白、补体水平等方面与Ⅴ型LN更为接近。 结论 膜性肾病ANA阳性患者具有异质性，其中肾脏病理表现为“满堂亮”的患者可能系早期Ⅴ型LN。【Abstract】 Objective To find out the clinical and pathological characteristics of early pure class Ⅴ lupus nephritis (LN). Methods A total of 24 patients with pure class Ⅴ LN diagnosed between January 2004 and November 2009 were included, and were compared with 50 antinuclear antibody (ANA)-positive patients with membranous nephropathy (MN) and 50 ANA-negative patients with MN. The clinical and pathological characteristics, laboratory test results were compared between the two groups. Then, 13 patients with "full house" fluorescence in renal biopsy specimens were chosen from the group of ANA-positive membranous nephropathy, whose clinical characteristics and laboratory test were compared with class Ⅴ LN patients. Results There were significant differences in sex ratio, age, positive rate of hepatitis B surface antigen (HBsAg), levels of hemoglobin, white blood cell, platelet,complement, endothelial and mesangial proliferation between class Ⅴ LN and ANA-negative MN group. However, the sex ratio, levels of white blood cell, platelet were similar between class Ⅴ LN and ANA-positive MN group. The renal biopsy specimens in patients with ANA-positive MN with "full house" fluorescence were similar with those in the patients with class Ⅴ LN in sex ratio, renal injury, hemoglobin and complement and the positive rate of hepatitis B surface antigen. Conclusion The demographic information and clinical manifestations in patients with class Ⅴ LN were similar to those in patients with ANA positive MN, especially in the patients wiht ANA-positive MN with "full house" fluorescence in renal biopsy specimens.
ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.