Sawai T, Uzuki M, Satoh N
Department of Pathology, Tohoku University Hospital, Sendai, Japan.
Tohoku J Exp Med. 1995 Oct;177(2):139-51. doi: 10.1620/tjem.177.139.
We have investigated the histopathological changes of kidney from 16 autopsy cases of children with systemic lupus erythematosus (SLE) using morphometric and immunohistochemical methods. These 16 cases accounted for 61% of the child autopsy cases with SLE registered in the data base "Annual of the Pathological Autopsy Cases in Japan" during the nine years from 1984 to 1992. Based on the histologic and morphometric findings, we divided the SLE-associated renal disease into three types: glomerular (3 cases), vascular (3 cases) and non-renal (10 cases) types. The glomerular and vascular types had renal lesions, while in the non-renal the main changes were found in extrarenal tissues. Of the 16 cases examined, three showed diffuse proliferative glomerulonephritis, with one of the three having crescentic formations in the glomeruli. Two of the three had wire-loop lesions. Recently the crescentic or wire-loop lesions are rarely experienced even in renal biopsy and autopsy of adult cases. The vascular type was characterized by necrotizing angiitis (1 case) and severe intimal thickening of interlobular arteries (2 cases), but they had no advanced glomerular lesion. Morphometric methods allowed us to demonstrate that the severity of arterial lesions, especially intimal thickening, does not correlate with that of glomerular lesions in children.
我们运用形态计量学和免疫组织化学方法，对16例系统性红斑狼疮（SLE）患儿尸检肾脏的组织病理学变化进行了研究。这16例病例占1984年至1992年9年间登记在日本病理尸检病例年鉴数据库中的SLE患儿尸检病例的61%。根据组织学和形态计量学结果，我们将SLE相关肾病分为三种类型：肾小球型（3例）、血管型（3例）和非肾脏型（10例）。肾小球型和血管型有肾脏病变，而非肾脏型主要病变见于肾外组织。在检查的16例病例中，3例表现为弥漫性增殖性肾小球肾炎，其中1例肾小球有新月体形成。3例中有2例有铁丝圈样病变。近来，即使在成人病例的肾活检和尸检中，新月体或铁丝圈样病变也很少见。血管型的特征为坏死性血管炎（1例）和小叶间动脉严重内膜增厚（2例），但它们没有严重的肾小球病变。形态计量学方法使我们能够证明，儿童动脉病变的严重程度，尤其是内膜增厚，与肾小球病变的严重程度无关。
