Guo Muyao, Xie Xiaoyun, Lin Wei, Zhou Yaou, Zhang Xiaoli
The Department of Rheumatology and Immunology, 159374Xiangya Hospital of Central South University, Changsha, China.
Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, 159374Xiangya Hospital of Central South University, Changsha, China.
Lupus. 2023 Feb;32(2):231-238. doi: 10.1177/09612033221141269. Epub 2022 Dec 2.
The aim of this study is to explore the association of podocyte injury with clinical features and outcomes in mesangial proliferative (Class II) lupus nephritis (LN).
We conducted a retrospective and clinicopathologic analysis with 576 LN patients with renal biopsy and screened 58 patients with Class II LN. Then, the 58 cases were divided into 4 groups based on the degree of podocyte damage and immune complex (IC) deposits on light microscope (histological and immunofluorescence) and electron microscope: Podocyte Injury Group, IC deposits Group, Podocyte Injury and IC Group, and Less-lesion Group. Clinical and pathologic information was collected from the patients' medical records at the time of the kidney biopsy and at follow-up. The data of demography, clinical parameters, therapy, remission, and relapse rates were analyzed and compared across groups.
A significant difference was observed in the ages of patients among four Class II LN groups. The onset age of patients with FPE ≥ 50% was significant later. The frequency of thrombocytopenia was statistically different among the four groups and the patients with FPE ≥ 50% had lower frequency of thrombocytopenia. Patients with FPE ≥ 50% had lower serum albumin, eGFR, and elevated proteinuria and serum lipids. In this study, most patients received glucocorticoids in combination with immunosuppressants. Among the 4 groups, the use of ACEI/ARBs was highest in the podocyte injury group. There was a statistical difference in the renal relapse rates among the 4 Class II LN groups. Moreover, the recurrence rate was higher in the FPE ≥ 50% group.
Our data identified Class II LN patients with podocyte injury (FPE ≥ 50%) present prominent renal damage and higher rate of renal relapse, suggesting more aggressive treatment and close follow-up for these patients.
本研究旨在探讨系膜增生性（II 级）狼疮性肾炎（LN）中足细胞损伤与临床特征及预后的相关性。
我们对 576 例经肾活检的 LN 患者进行了回顾性临床病理分析，筛选出 58 例 II 级 LN 患者。然后，根据光镜（组织学和免疫荧光）及电镜下足细胞损伤程度和免疫复合物（IC）沉积情况，将这 58 例患者分为 4 组：足细胞损伤组、IC 沉积组、足细胞损伤合并 IC 组和轻度病变组。在肾活检时及随访期间，从患者病历中收集临床和病理信息。分析并比较各组的人口统计学、临床参数、治疗、缓解及复发率数据。
在四个 II 级 LN 组患者的年龄方面观察到显著差异。足细胞足突融合率（FPE）≥50%的患者发病年龄显著较晚。四组患者血小板减少症的发生率存在统计学差异，FPE≥50%的患者血小板减少症发生率较低。FPE≥50%的患者血清白蛋白、估算肾小球滤过率（eGFR）较低，蛋白尿和血脂升高。在本研究中，大多数患者接受了糖皮质激素联合免疫抑制剂治疗。在 4 组中，足细胞损伤组使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素 II 受体阻滞剂（ARBs）的比例最高。四个 II 级 LN 组的肾脏复发率存在统计学差异。此外，FPE≥50%组的复发率更高。
我们的数据表明，足细胞损伤（FPE≥50%）的 II 级 LN 患者存在明显的肾脏损害和较高的肾脏复发率，提示对这些患者应采取更积极的治疗及密切随访。
