【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.
Objective To systematically review the effect of allopurinol on renal function in patients with chronic kidney disease (CKD). Methods The PubMed, EMbase, Cochrane Library, WanFang Data, CNKI, and VIP databases were searched for randomized controlled trials (RCTs) of the effect of allopurinol on renal function in patients with CKD. Databases for articles published between establishment of the database and April 28, 2021 were searched. Two evaluators independently screened the literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 was then used for meta-analysis. Results A total of 20 RCTs comprising 2 338 patients were included. The results of meta-analysis showed that compared with the control group, allopurinol substantially reduced the serum uric acid (MD=−2.48, 95%CI −3.08 to −1.89, P<0.01). In addition, the effect of allopurinol on slowing the decline in eGFR was influenced by the serum uric acid concentration. Participants taking allopurinol whose serum uric acid concentrations were maintained at >6 mg/dL showed a slower decline in eGFR (MD=5.03, 95%CI 1.76 to 8.31, P<0.01). However, there was no difference in the decline in eGFR between the two groups when the serum uric acid concentration of the participants was <6 mg/dL. Among participants with CKD and moderate renal dysfunction at baseline, those taking allopurinol showed a slower decline in eGFR than controls (MD=3.33, 95%CI 1.14 to 5.52, P<0.01). A further subgroup analysis showed that those who maintained their serum uric acid concentration above 6 mg/dL experienced a slower decline in eGFR (MD=5.46, 95%CI 2.06 to 8.86, P<0.01). However, when the serum uric acid concentration was <6 mg/dL, there was no difference between the allopurinol and control groups. Moreover, the serum creatinine concentration of the allopurinol group was lower than that of the control group after the intervention (MD=−0.39, 95%CI −0.58 to −0.19), P<0.01). However, there was no significant difference in the incidence of progression to end-stage kidney disease between the two groups (RR=0.96, 95%CI 0.65 to 1.42, P=0.85). Conclusion Allopurinol can substantially reduce serum uric acid and may protect the kidneys of patients with CKD when the serum uric acid concentration is maintained above 6 mg/dL.