Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies

王渊; 黄鑫; 张均; 刘力; 钱丹; 唐莎; 张莹; 赵景宏; 黄云剑; 张静波

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Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies

更新时间：2026-01-09

- Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies
- Journal of Army Medical University Vol. 37, Issue 7, Pages: 678-683(2015)
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  CLC： R181.32;R392.3;R593.242
- Published：2015
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王渊,黄鑫,张均,刘力,钱丹,唐莎,张莹,赵景宏,黄云剑,张静波.狼疮肾炎合并抗中性粒细胞胞浆抗体阳性的临床分析[J].陆军军医大学学报(原第三军医大学学报),2015,37(07):678-683.

　Wang Yuan,Huang Xin,Zhang Jun,Liu Li,Qian Dan,Tang Sha,Zhang Ying,Zhao Jinghong,Huang Yunjian,Zhang Jingbo.Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(07):678-683.
王渊,黄鑫,张均,刘力,钱丹,唐莎,张莹,赵景宏,黄云剑,张静波.狼疮肾炎合并抗中性粒细胞胞浆抗体阳性的临床分析[J].陆军军医大学学报(原第三军医大学学报),2015,37(07):678-683. DOI：

　Wang Yuan,Huang Xin,Zhang Jun,Liu Li,Qian Dan,Tang Sha,Zhang Ying,Zhao Jinghong,Huang Yunjian,Zhang Jingbo.Clinical analysis of lupus nephritis with positive anti-neutrophil cytoplasmic antibodies[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(07):678-683. DOI：

摘要

目的探讨狼疮肾炎（lupus nephritis

LN）合并抗中性粒细胞胞浆抗体（antineutrophil cytoplasmic antibodies

ANCA）阳性患者的临床病理特征及预后。方法回顾性分析2011-2013年我院肾内科穿刺活检确诊的154例LN患者的临床表现及肾脏病理。采用欧蒙印迹法及间接免疫荧光法测定患者血清中的ANCA，分为ANCA阳性组和ANCA阴性组，比较两组患者流行病学、临床表现、实验室检查、肾脏病理、疾病活动度以及预后情况之间的差异。结果 ANCA阳性的LN患者26例（16.88%），其中MPO-ANCA 24例，PR3-ANCA 2例；ANCA阴性的LN患者128例。26例ANCA阳性的LN患者，脱发、口腔溃疡、光过敏及皮损的发生率明显高于ANCA阴性组（P值分别为0.007、0.016、0.022）；抗核小体抗体及抗心磷脂抗体的发生率明显高于ANCA阴性组（P值分别为0.001、0.005）；补体C3水平明显低于ANCA阴性组（P=0.034）。ANCA阳性组肾脏病理的肾小球球性硬化发生率及硬化比例、慢性指数（chronic index，CI）评分显著高于ANCA阴性组（P值分别为0.003、0.004、0.013），而病理类型分布、新月体形成、血管袢坏死、微血栓形成、肾小管萎缩及肾间质纤维化、活动指数（activity index，AI）评分、肾小管损伤（tubular interstitial lesion，TIL）评分、狼疮活动度（SLEDAI）评分两组间差异无统计学意义（P0.05）。ANCA阳性组尿蛋白转阴率明显低于ANCA阴性组（χ

=7.421，P=0.006），两组间死亡率差异无统计学意义（P0.05）。结论 ANCA阳性的LN患者易出现脱发、口腔溃疡、光过敏及皮损，肾脏病理可逆程度及预后较差，需早期积极治疗。

Abstract

Objective To investigate the clinicopathological features and outcomes of lupus nephritis (LN) with being positive to anti-neutrophil cytoplasmic antibodies (ANCA). Methods Clinical data of 154 patients with LN who underwent renal biopsy in our department from January 2011 to December 2013 were collected and analyzed retrospectively. According to the results of EUROBlot and indirect immunofluorescence staining

the patients were divided into 2 groups. ANCA-positive and ANCA-negative. The clinical manifestations

laboratory examinations results

pathologic features

systemic lupus erythematosus disease activity index (SLEDAI) and prognosis were compared between ANCA-positive and ANCA-negative groups. Results Among all the patients presented in this study

there were 26 patients (16.88%) positive to ANCA [including 24 cases positive to myeloperoxidase (MPO)-ANCA and 2 cases positive to proteinase 3 (PR3)-ANCA]

and 128 LN patients negative to ANCA. The incidences of alopecia

oral ulcer

photosensitivity and skin lesion were obviously higher in the positive group than the negative one (P0.007

0.016

0.022). So were the frequencies of being positive to anti-nucleosome antibody and anti-cardiolipin antibody (P0.001

0.005). But the level of C3 was significant lower in the former than the latter groups (P=0.034). The incidence and percentage of glomerular sclerosis and chronic index (CI) were higher in positive group than the negative group (P0.003

0.004

0.013). There were no significant differences in pathological types

activity index (AI)

tubular interstitial lesion (TIL)

SLEDAI

and severities of crescent formation

vascular loop necrosis

micro thrombosis

renal tubular atrophy and renal interstitial fibrosis between the 2 groups (P0.05). The mortality showed no significant difference either (P0.05). The negative conversion rate of proteinuria was obviously lower in the positive than the negative groups (Chi square=7.421

P=0.006). Conclusion Alopecia

oral ulcer

photosensitivity and skin lesion are more common in LN patients with positive ANCA. They also have worse renal pathological degree of reversibility and poorly outcomes. So the patients need to be treated as early as possible.

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