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在系统性红斑狼疮(SLE)中,肾脏损害不仅发生率高,且预后也较无肾损者差。我院1964～1984年收治的230例SLE中,临床诊断有狼疮肾炎者170例,占73.9％,其中死亡者41例,病死率为24.1％。临床诊断无狼疮肾炎者仅60例,占26.1％,其中死亡5例,病死率为8.3％。在41例死亡的有狼疮肾炎的患者中,32例是直接或间接死于狼疮肾炎,即18例死于尿毒症,14例死于感染(因肾炎长期治疗,免疫功能低下);另9例分别死于心衰(4例)、狼疮脑病(3例)、狼疮肠病(1例)和自溢(1例)。换言之,18.8％(32/170)的狼疮肾炎为“难治的”,即对皮质醇类激素(下称激素)、免疫抑制剂及中医中药等治疗无显著疗效。我科自1972年开始用联合抗凝疗法治疗这类难治的狼疮肾炎,取得较好疗效,现将抗凝治疗后观察时间超过一年的14例报道如下。
In systemic lupus erythematosus (SLE), kidney damage is not only high in incidence, but also has a worse prognosis than without renal damage. In our hospital from 1964 to 1984 admitted 230 cases of SLE, clinical diagnosis of lupus nephritis in 170 cases, accounting for 73.9%, of which 41 died, the case fatality rate was 24.1%. Clinical diagnosis of lupus nephritis no more than 60 cases, accounting for 26.1%, of which 5 died, the mortality rate was 8.3%. Of the 41 patients with lupus nephritis who died, 32 were directly or indirectly dying of lupus nephritis, ie 18 died of uremia and 14 died of infection (due to long-term treatment of nephritis, immunocompromised); the other 9 Died of heart failure (4 cases), lupoid encephalopathy (3 cases), lupus enteropathy (1 case) and spontaneous overflow (1 case). In other words, 18.8% (32/170) of lupus nephritis was “refractory”, that is, there was no significant effect on the treatment of corticosteroids (hereinafter referred to as hormones), immunosuppressive agents and traditional Chinese medicine. Our department since 1972 with the combination of anticoagulant therapy for the treatment of such refractory lupus nephritis, and achieved good results, the anticoagulant therapy is now observed for more than a year after the treatment of 14 cases are reported below.