Grishman E, Venkataseshan V S
Department of Pathology, Mount Sinai School of Medicine, City Hospital Center Elmhurst, New York, New York.
Mod Pathol. 1988 May;1(3):235-41.
Three groups of kidney specimens from patients with systemic lupus erythematosus (SLE) were examined for histologic evidence of vascular lesions in small arteries and arterioles. Group 1 consisted of 24 autopsy kidneys from patients who died before the advent of steroid therapy, and Group 2, of 26 more recent autopsy specimens from patients treated with steroids and/or immunosuppressive drugs. Group 3 comprised 276 renal biopsies. Group 1 showed characteristic subendothelial eosinophilic deposits in small arteries and arterioles of 8 cases; Group 2 showed similar lesions in 5 specimens, while 3 others revealed evidence of resorption of deposits. Deposits were characterized by clumping and were delimited toward the media by a thick basement membrane. Only one case showed necrotizing arteritis resembling polyarteritis nodosa. Group 3 presented vascular deposits in 19 cases and thrombotic microangiopathy in 2. Electron microscopic appearance of some of the deposits is described. Immunofluorescence microscopy showed a mixture of IgG, IgA, and IgM in 7 cases, a finding that was not seen in a group of non-lupus patients with various vascular lesions. Vascular deposits are generally rare in systemic lupus erythematosus, although in autopsies widely scattered involvement of arteries and arterioles was seen in nearly 1/3 of the cases. The deposits were more common in male patients. The evolution of the lesions could be followed through various stages to eventual sclerosis, particularly in patients treated with steroids or immunosuppressants. Some deposits appeared to resolve after treatment. Patients with vascular deposits had more severe glomerular disease and a more serious clinical course. Thrombotic microangiopathy appears to be a secondary phenomenon whose pathogenesis is unknown.
对三组系统性红斑狼疮（SLE）患者的肾脏标本进行检查，以寻找小动脉和小动脉血管病变的组织学证据。第一组由24例在类固醇治疗出现之前死亡患者的尸检肾脏组成，第二组由26例近期接受类固醇和/或免疫抑制药物治疗患者的尸检标本组成。第三组包括276例肾活检标本。第一组在8例患者的小动脉和小动脉中显示出特征性的内皮下嗜酸性沉积物；第二组在5个标本中显示出类似病变，而另外3个标本显示出沉积物吸收的证据。沉积物的特征是结块，并由厚的基底膜向中膜界定。只有1例显示出类似于结节性多动脉炎的坏死性动脉炎。第三组有19例出现血管沉积物，2例出现血栓性微血管病。描述了部分沉积物的电子显微镜外观。免疫荧光显微镜检查显示7例患者中有IgG、IgA和IgM的混合物，这一发现未见于一组患有各种血管病变的非狼疮患者。血管沉积物在系统性红斑狼疮中通常很少见，尽管在尸检中近1/3的病例可见动脉和小动脉广泛散在受累。沉积物在男性患者中更常见。病变的演变可以通过各个阶段发展到最终的硬化，特别是在接受类固醇或免疫抑制剂治疗的患者中。一些沉积物在治疗后似乎消退。有血管沉积物的患者肾小球疾病更严重，临床病程更严重。血栓性微血管病似乎是一种继发现象，其发病机制尚不清楚。
