Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis

Jun ZHANG; Maozhi TANG

doi:10.16016/j.1000-5404.201709213

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Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis

Clinical Medicine | 更新时间：2026-01-09

- Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis
- Journal of Third Military Medical University Vol. 40, Issue 5, Pages: 449-453(2018)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院肾科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201709213
  CLC： R181.32;R543.7;R593.242
- Received：28 September 2017，
  
  Revised：2017-11-08，
  
  Published：15 March 2018
- 稿件说明：
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Jun ZHANG, Maozhi TANG. Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis[J]. Journal of Third Military Medical University, 2018, 40(5): 449-453.
DOI：

Jun ZHANG, Maozhi TANG. Clinical risk factors of thrombotic microvascular lesions in 55 patients with lupus nephritis[J]. Journal of Third Military Medical University, 2018, 40(5): 449-453. DOI： 10.16016/j.1000-5404.201709213.

摘要

目的

分析狼疮性肾炎(lupus nephritis

LN)伴血栓性微血管病变(thrombotic microangiopathy

TMA)的临床表现、实验室特点、病理特点、临床治疗结果，探讨其临床危险因素。

方法

选取2008年8月至2016年7月在本科接受肾活检、病理诊断为LN伴TMA患者55例，分为存活组(34例)与死亡组(21例)；利用Logistic回归分析发生死亡的临床危险因素。

结果

从临床表现、实验室检查、病理特点、临床治疗结果等因素进行分析，与存活组比较，死亡组急诊血液透析、感染发生率较高(

0.01)，补体C3较低(

=0.04)

CRP(

=0.047)、24 h尿蛋白定量(

=0.02)、血肌酐(serum creatinine)水平较高(

=0.04)，SLEDAI-2000评分较高(

=0.02)；当血小板计数(PLT)

50×10

/L时，死亡风险明显增加。Logistic回归分析结果显示，急诊透析、感染、PLT

50×10

/L时为患者死亡的独立危险因素。

结论

急诊透析、感染、血小板降低是伴TMA狼疮性肾炎患者临床危险因素。

Abstract

Objective

To investigate the clinical manifestations

features of laboratory results

pathological characteristics

clinical risk factors and outcomes of lupus nephritis (LN) patients with thrombotic microangiopathy (TMA).

Methods

Totally 55 LN patients with TMA diagnosed pathologically in our department from August 2008 to July 2016 were enrolled in this study. They were divided into survival group (

=34) and dead group (

=21). Logistic regression analysis was used to analyze the clinical risk factors of death.

Results

Based on the clinical manifestations

laboratory tests

pathological features

and clinical outcomes

our analyses indicated that the dead group had higher incidences of acute hemodialysis and infection (

0.01)

lower complement C3 level (

=0.04)

but high levels of C-reactive protein (

=0.047)

24-hour urine protein (

=0.02) and serum creatinine (

=0.04)

and higher SLEDAI 2000 score (

=0.02) when compared with the survival group. The risk of death was increased significantly when platelet count

50×10

/L. Logistic regression analysis showed emergency dialysis

infection and lower platelet count (

50×10

/L) were independent risk factors for death.

Conclusion

Emergency dialysis

infection

and decreased platelet count are risk factors for TMA in LN patients.

关键词

Keywords

references

GALBUSERA M, NORIS M, REMUZZI G. Thrombotic thrombocytopenic purpura—then and now[J]. Semin Thromb Hemost, 2006, 32(2): 81-89. DOI:10.1055/S-2006-939763.

LANSIGAN F, ISUFI I, TAGOE C E. Microangiopathic haemolytic anaemia resembling thrombotic thrombocytopenic purpura in systemic lupus erythematosus: the role of ADAMTS13[J]. Rheumatology(Oxford), 2011, 50:824-829. DOI:10.1093/rheumatology/keq395.

MOAKE J L. Thrombotic microangiopathies[J]. N Engl J Med 2002, 347(8):589-600. DOI:10.1056/NEJMRA020528.

GEORGE J N. Clinical practice. Thrombotic thrombocytopenic purpura[J]. N Engl J Med, 2006, 354(18):1927-1935. DOI:10.1056/NEJMcp 053024.

FURLAN M, ROBLES R, GALBUSERA M, et al . von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome[J ] . N Engl J Med, 1998, 339(22):1578-1584.

CLEARY T G. Cytotoxin-producing Escherichia coli and the hemolytic uremic syndrome[J]. Pediatr Clin North Am, 1988, 35(3):485-501. DOI:10.1016/s0031-3955(16)36467-7.

COHEN D, KOOPMANS M, KREMER HOVINGA I C, et al . Potential for glomerular C4d as an indicator of thrombotic microangiopathy in lupus nephritis[J ] . Arthritis Rheum, 2008, 58(8):2460-2469. DOI:10.1002/art.23662.

KWOK S K, JU J H, CHO C S, et al .Thrombotic thrombocytopenic purpura in systemic lupus erythema-tosus: risk factors and clinical outcome: a single centre study[J ] . Lupus, 2009, 18(1):16-21. DOI:10.1177/0961203308094360.

HOCHBERG M C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40(9): 1725. DOI:10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO; 2-Y.

BOMBARDIER C, GLADMAN D D, UROWITZ M B, et al . Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE[J ] . Arthritis Rheum, 1992, 35(6):630-640.

LASZIK Z G, KAMBHAM N, SILVA F G. Thrombotic microangiopathies[M ] //JENNETT J C, D'AGATI V D, OLSON J L, et al . Heptinstall's Pathology of the Kidney. Philadelphia: Lippincott Williams & Wilkins, 2014.

SHATZEL J J, TAYLOR J A. Syndromes of thrombotic microangiopathy[J]. Med Clin North Am, 2017, 101(2):395-415. DOI:10.1016/j.mcna.2016.09.010.

SONG D, WU L H, WANG F M, et al .The spectrum of renal thrombotic microangiopathy in lupus nephritis[J ] . Arthritis Res Ther, 2013, 15(1):R12. DOI:10.1186/ar4142.

CHEN M H, CHEN M H, CHEN W S, et al . Thrombotic microangiopathy in systemic lupus erythematosus: a cohort study in North Taiwan[J ] . Rheumatology (Oxford, England), 2011, 50(4): 768-775. DOI:10.1093/rheumatology/keq311.

HU W X, LIU Z Z, CHEN H P, et al . Clinical characteristics and prognosis of diffuse proliferative lupus nephritis with thrombotic microangiopathy[J ] . Lupus, 2010, 19(14): 1591-1598. DOI:10.1177/0961203310376523.

王静, 胡伟新, 陈惠萍, 等.Ⅳ型狼疮性肾炎伴血栓性微血管病变的临床特点及预后[J].肾脏病与透析肾移植杂志, 2007, 16(4):322-328.

WANG J, HU W X, CHEN H P, et al . Clinicopathologic characterisitics and outcomes in patients with class Ⅳ lupus nephritis presented with thrombotic microangiopathy[J ] . J Nephrol Dialy Transplant, 2007, 16(4):322-328.

ZHENG T, CHUNLEI L, ZHEN W, et al . Clinical-pathological features and prognosis of thrombotic thrombocytopenic purpura in patients with lupus nephritis[J ] . Am J Med Sci, 2009, 338(5):343-347. DOI:10.1097/MAJ.0b013e3181b0c872.

YU F, TAN Y, ZHAO M H. Lupus nephritis combined with renal injury due to thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome[J]. Nephrol Dial Transplant, 2010, 25(1):145-152. DOI:10.1093/ndt/gfp421.

SATO N, OHSAWA I, NAGAMACHI S, et al . Significance of glomerular activation of the alternative pathway and lectin pathway in lupus nephritis[J ] . Lupus, 2011, 20(13):1378-1386. DOI:10.1177/0961203311415561.

POLLOCK K G, YOUNG D, BEATTIE T J, et al . Clinical surveillance of thrombotic microangiopathies in Scotland, 2003-2005[J ] . Epidemiol Infect, 2008, 136(1):115-1121. DOI:10.1017/S0950268807008217.

AL-RAYES H, AL-SWAILEM R, ARFIN M, et al . Systemic lupus erythematosus and infections: a retrospective study in Saudis[J ] . Lupus, 2007, 16(9):755-763. DOI:10.1177/0961203307079943.

FALAGAS M E, MANTA K G, BETSI G I, et al . Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review[J ] . Clin Rheumatol, 2007, 26(5):663-670. DOI:10.1007/s10067-006-0441-9.

BELL W R, BRAINE H G, NESS P M, et al . Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients[J ] . N Engl J Med, 1991, 325(6):398-403. DOI:10.1056/NEJM199108083250 605.

DOUGLAS K W, POLLOCK K G, YOUNG D, et al . Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: a single-institution experience[J ] . J Clin Apher, 2010, 25(2):47-53. DOI:10.1002/jca.20226.

WEITZ I C. Complement the hemostatic system: an intimate relationship[J]. Thromb Res, 2014, 133(Suppl 2):S117-S121. DOI:10.1016/S0049-3848(14)50020-5.

NORIS M, REMUZZI G. Cardiovascular complications in atypical haemolytic uraemic syndrome[J]. Nat Rev Nephrol, 2014, 10(3):174-180. DOI:10.1038/nrneph.2013.280.

GOLDBERG R J, NAKAGAWA T, JOHNSON R J, et al . The role of endothelial cell injury in thrombotic microangiopathy[J ] . Am J Kidney Dis, 2010, 56(6):1168-1174.DOI:10.1053/j.ajkd.2010.06.006.

WEITZ I C. Atypical hemolytic uremic syndrome: the role of complement pathway gene mutation analysis[J]. Clin Adv Hematol Oncol, 2014, 12(4):266-268.

VEYRADIER A, MEYER D.Thrombotic thrombocytopenic purpura and its diagnosis[J]. J Thromb Haemost, 2005, 3(11):2420-2427.DOI:10.1111/j.1538-7836.2005.01350.x.

ROCK G A, SHUMAK K H, BUSKARD N A, et al . Comparison of plasma exchange with plasma infusion in the treatment of throm-botic thrombocytopenic purpura.Canadian Apheresis Study Group[J ] . N Engl J Med, 1991, 325(6):393-397. DOI:10.1056/NEJM 199108083250604.

FERRARI S, SCHEIFLINGER F, RIEGER M, et al . Prognostic value of anti-ADAMTS 13 antibody features (Ig isotype, titer, and inhibitory effect) in a cohort of 35 adult French patients undergoing a first episode of thrombotic microangiopathy with undetectable ADAMTS 13 activity[J ] . Blood, 2007, 109(7): 2815-2822. DOI:10.1182/blood-2006-02-006064.

EL-HUSSEINI A, HANNAN S, AWAD A, et al . Thrombotic microangiopathy in systemic lupus erythematosus: efficacy of eculizumab[J ] . Am J Kidney Dis, 2015, 65(1):127-130. DOI:10.1053/j.ajkd.2014.07.031.

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