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中文摘要：
目的探讨弥漫增殖型狼疮肾炎（Ⅳ型）的病理转型特点及影响因素。方法经肾活检确诊的Ⅳ型狼疮肾炎32例，平均间隔686天后行重复肾活检，观察其病理转型特点与临床表现的关系。结果病理转型为Ⅱ型者12例、Ⅲ型者3例、Ⅳ型者13例、Ⅴ型者2例、Ⅵ型者1例。临床病理分析显示病理转型为Ⅲ型及Ⅳ型者舒张压、24h尿蛋白定量、血清BUN与SCr明显升高。单因素分析显示男性、首次肾活检收缩压与舒张压均升高、尿红细胞数较多、肾脏血管病变的发生比率高、重复肾活检间隔时间长、未应用免疫抑制剂的患者多转型为Ⅲ型和Ⅳ型；多因素分析显示重复肾活检间隔时间、未用免疫抑制剂治疗与肾脏血管病变的差异具有统计学意义。结论Ⅳ型狼疮肾炎可有各种病理转型。恰当地治疗可以缓解病情，有助于改善病理类型与远期预后。
英文摘要：
Objective To investigate the characteristics of pathological transformation in patients with diffuse proliferative lupus nephritis observed by repeated renal biopsy. Method 32 patients diagnosed as WHO type Ⅳ lupus nephritis were subjected to repeated biopsy after average 686 days. Relationship between pathological transformation and clinical manifestations were analyzed. Relevant factors for pathological transformation were evaluated with univariate and multivariate analysis. Resuits Pathological transformation to type Ⅱ occurred in 12, Ⅲ in 13, Ⅴ in 2, Ⅵ in 1 and 13 remained type Ⅳ. Patients with type Ⅲ and Ⅳ have elevated diastolic blood pressure, higher levels of proteinuria, serum BUN and creatinine（P〈0. 05 or P〈0. 01）. Univariate analysis showed male, elevated systolic and diastolic blood pressure, increased haematuria, renal vasculopathies, long interval between the two biopsies and without administration of immunosuppressive agents were prone to transform to type Ⅲ and Ⅳ（P = 0. 0034～0. 0728）. A multivariate analysis showed longer intervals, lack of immusuppressive treatment and renal vasculopathies were predictives of worse pathological transformations（P = 0. 0366～0. 0591 ）. Conclusions Type IV lupus nephritis may undergo different pathological transformation. Appropriate treatment and prevention of relapse can help to improve the pathological type and long-term prognosis.
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