LUPUS ANTICOAGULANT IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A CLINICAL AND RENAL PATHOLOGICAL-STUDY
LUPUS ANTICOAGULANT IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A CLINICAL AND RENAL PATHOLOGICAL-STUDY
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DOI：
10.1016/s0272-6386(12)70258-5
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发表时间：
1992-11-01
影响因子：
13.2
通讯作者：
HOLLEY, KE
中科院分区：
文献类型：
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作者：
FARRUGIA, E;TORRES, VE;HOLLEY, KE
循环狼疮抗凝剂（LA）与大血管和小血管血栓形成有关。为了确定LA与肾微循环血栓形成相关的频率，我们在25年的时间里发现了33例系统性红斑狼疮（SLE）、肾功能不全和LA患者（LA组），32例肾性SLE患者（大体凝血筛查正常）在年龄、性别和活检时间上进行了匹配（C组）。浆膜炎、神经精神疾病、白细胞减少、血小板减少、溶血、抗ds - dna升高和补体减少的患病率相似。关节炎较少，生物假阳性（BFP）梅毒血清学在洛杉矶更为常见。更多的LA患者有血栓形成事件（LA 39%vC 13%; P = 0.014）；出血发作，包括活检后，相似。活检时，高血压（LA 55%, C 41%）、血清肌酐（平均值±SD: LA 186±168 μmol/L[2.1±1.9 mg/dL]vC 150±168 μmol/L[1.7±1.9 mg/dL]）和蛋白尿（LA 2.6±3.1 g/24 hvC 3.1±2.7）相似。世界卫生组织（WHO）的病变分类、活动性和慢性指数以及免疫荧光（IF）和电子显微镜（EM）检查结果没有显著差异。33例LA患者中有5例出现闭塞性肾小球、小动脉和动脉纤维蛋白血栓，并伴有不同程度的肾血栓性微血管病变，但32例C患者中无血栓形成（P = 0.053）；这5例患者中有3例在活检后不久死亡。总的来说，LA和c之间的死亡率没有差异。我们得出结论，大多数SLE、肾功能不全和LA患者的肾脏形态学表现与没有LA的患者没有区别。然而，少数LA患者在活检中有血栓性微血管病变，这伴随着较差的预后。
Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified over a 25-year period (LA group) and 32 patients with renal SLE but with normal gross coagulation screen were matched for age, sex, and biopsy timing (C group). Prevalences of serositis, neuropsychiatric illness, leukopenia, thrombocytopenia, hemolysis, anti-DS-DNA elevation, and complement reduction were similar. Arthritis was less and biologic false-positive (BFP) syphilis serology more common in LA. More LA patients had thrombotic events (LA 39%vC 13%; P = 0.014); bleeding episodes, including postbiopsy, were similar. At biopsy, hypertension (LA 55%, C 41 %), serum creatinine (mean ± SD: LA 186 ± 168 μmol/ L [2.1 ± 1.9 mg/dL]vC 150 ± 168 μmol/L [1.7 ± 1.9 mg/dL]) and proteinurla (LA 2.6 ± 3.1 g/24 hvC 3.1 ± 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. However, a significant minority of LA patients have thrombotic microangiopathy in their biopsy, which is accompanied by a worse prognosis.