弥漫性增殖性狼疮性肾炎的预后因素

Prognostic factors of diffuse proliferative lupus nephritis.

作者信息

Lim C S, Chin H J, Jung Y C, Kim Y S, Ahn C, Han J S, Kim S, Lee J S

机构信息

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University, Korea.

出版信息

Clin Nephrol. 1999 Sep;52(3):139-47.

PMID:10499308

Abstract

BACKGROUND

Diffuse proliferative lupus nephritis (DPLN) is the most severe form in lupus nephritis.

PATIENTS AND METHODS

We retrospectively analyzed 90 DPLN patients who were confirmed by kidney biopsy and treated at least for 12 months to compare the effectiveness of treatment modalities and to investigate the prognostic factors of DPLN. The patients were categorized to intravenous cyclophosphamide pulse (CY) group and oral corticosteroid (with/without cytotoxic drug, PO) group.

RESULTS

When the CY group (69 patients) and PO group (21 patients) were compared, there were no differences between two groups in sex, age, histologic chronicity index (CI, 4.55 vs 3.76; CY vs PO, respectively), mortality rate (4.3% vs 0%), remission rate of nephritis (at 3-year 59. 1 % vs 75.5%), renal survival rate (at 5-year 88.0% vs 91.7%) and complications of treatment, but significant differences in the frequency of nephrotic syndrome (66.7% vs 33.3%) and initial azotemia (30.4% vs 0%). histologic activity index (7.14 vs 4.33) and relapse rate (2.9% vs 42.9%). When the remission group (49 patients) and non-remission group (41 patients) were compared, CI, initial renal insufficiency, male sex and the duration of nephritis were the prognostic factors for remission in univariate analysis, and male sex (OR 10.99) and CI (OR 9.89) in multivariate analysis. When the remission group (35 patients) and non-remission (34 patients) group were compared in the CY group, CI was the prognostic factor in univariate analysis, and CI (OR 8.63) and male sex (OR 5.54) in multivariate analysis. The initial renal insufficiency (OR 12.74) and male sex (OR 7.99) were the prognostic factors for renal survival. The renal survival rate was 100% in remission-induced patients.

CONCLUSION

We conclude that CI, male sex, initial renal insufficiency were the prognostic factors of DPLN, and treatment with oral corticosteroid could induce remission in patients who had mild histologic and clinical features. Therefore it would be necessary to evaluate the prognostic factors before the selection of treatment modality.

摘要

背景

弥漫性增殖性狼疮性肾炎（DPLN）是狼疮性肾炎最严重的形式。

患者与方法

我们回顾性分析了90例经肾活检确诊且接受至少12个月治疗的DPLN患者，以比较治疗方式的有效性并研究DPLN的预后因素。患者被分为静脉注射环磷酰胺脉冲（CY）组和口服皮质类固醇（加/不加细胞毒性药物，PO）组。

结果

比较CY组（69例患者）和PO组（21例患者）时，两组在性别、年龄、组织学慢性指数（CI，分别为4.55对3.76；CY对PO）、死亡率（4.3%对0%）、肾炎缓解率（3年时为59.1%对75.5%）、肾脏存活率（5年时为88.0%对91.7%）及治疗并发症方面无差异，但在肾病综合征发生率（66.7%对33.3%）、初始氮质血症（30.4%对0%）、组织学活动指数（7.14对4.33）及复发率（2.9%对42.9%）方面存在显著差异。比较缓解组（49例患者）和未缓解组（41例患者）时，单因素分析中CI、初始肾功能不全、男性及肾炎病程是缓解的预后因素，多因素分析中男性（比值比10.99）和CI（比值比9.89）是预后因素。在CY组中比较缓解组（35例患者）和未缓解组（34例患者）时，单因素分析中CI是预后因素，多因素分析中CI（比值比8.63）和男性（比值比5.54）是预后因素。初始肾功能不全（比值比12.74）和男性（比值比7.99）是肾脏存活的预后因素。诱导缓解患者的肾脏存活率为100%。