Makino H, Hayashi Y, Yamasaki Y, Shikata K, Kashihara N, Kira S, Ota Z
Third Department of Internal Medicine, Okayama University Medical School.
Intern Med. 1994 Aug;33(8):461-5. doi: 10.2169/internalmedicine.33.461.
The significance of necrosis (karyorrhexis), among the most characteristic findings in lupus nephritis, was evaluated by studying the correlation between the existence of necrosis in renal biopsy specimens and laboratory findings. The subjects were 54 patients with diffuse proliferative lupus nephritis and 6 patients with focal proliferative lupus nephritis selected from 143 patients with lupus nephritis. We also compared the clinical course of oral prednisolone and intravenous methylprednisolone pulse therapies after steroid administration. Compared with the non-necrosis group, the necrosis group had significantly lower CH50 levels and more proteinuria. Patients with necrosis were effectively treated with repeated pulse therapy judging by immunological activity and the decrease in proteinuria at an early stage, but responded poorly to oral steroid therapy. As the presence of necrosis in cases of lupus nephritis means high immunological activity of the lesion and there is responsiveness to a large dose of steroids, extensive immunosuppressive therapy including methylprednisolone pulse therapy should be applied to these patients.
通过研究肾活检标本中坏死的存在与实验室检查结果之间的相关性，评估了坏死（核碎裂）在狼疮性肾炎最具特征性表现中的意义。研究对象为从143例狼疮性肾炎患者中选出的54例弥漫性增殖性狼疮性肾炎患者和6例局灶性增殖性狼疮性肾炎患者。我们还比较了给予类固醇后口服泼尼松龙和静脉注射甲泼尼龙冲击疗法的临床过程。与非坏死组相比，坏死组的CH50水平显著更低，蛋白尿更多。从免疫活性和早期蛋白尿减少情况判断，坏死患者经重复冲击疗法可得到有效治疗，但对口服类固醇疗法反应不佳。由于狼疮性肾炎病例中坏死的存在意味着病变具有高免疫活性，且对大剂量类固醇有反应性，因此应将包括甲泼尼龙冲击疗法在内的广泛免疫抑制疗法应用于这些患者。
