Najafi C C, Korbet S M, Lewis E J, Schwartz M M, Reichlin M, Evans J
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Kidney Int. 2001 Jun;59(6):2156-63. doi: 10.1046/j.1523-1755.2001.00730.x.
Patients with systemic lupus erythematosus have a spectrum of glomerular disease, but the different patterns of glomerular injury identified within the general category of "severe" lupus glomerulonephritis are responsible for much of the morbidity and mortality in this disease. The glomerular injury patterns seen with severe lupus glomerulonephritis have been separated into distinct histopathologic groups to determine whether they can predict long-term patient outcome.
We analyzed the clinical follow-up of 85 patients participating in a controlled prospective therapeutic trial for the treatment of severe lupus glomerulonephritis conducted from April 1981 to December 1988, with an average follow-up of 10 years. Patients were classified according to the 1982 World Health Organization classification for lupus glomerulonephritis.
During the course of follow-up [120 +/- 65 (SD) months], 60% of patients with category IV (diffuse proliferative glomerulonephritis) lesions entered a remission compared with only 38% of patients with category III (> or =50%, focal and segmental glomerulonephritis) lesions and 27% of patients with category Vc (> or =50%) and Vd (P < 0.05). Renal survival at 10 years was 75% for those with category IV lesions, 47% for patients with category Vc (> or =50%) and Vd, and 52% for patients with category III (> or =50%) lesions (P < 0.05). Based on multivariate analysis, patients with category III (> or =50%) or Vc (> or =50%) and Vd lesions had a relative risk of progression to end-stage renal disease 2.9 times that of category IV patients (P < 0.01), while the likelihood of entering a remission was 8.2 times greater for category IV patients (P = 0.0001).
The histopathologic categorization among patients with severe lupus glomerulonephritis provides information relevant to their long-term outcome.
系统性红斑狼疮患者存在一系列肾小球疾病，但在“重度”狼疮性肾炎这一总体类别中所识别出的不同肾小球损伤模式是该疾病诸多发病率和死亡率的原因。重度狼疮性肾炎所呈现的肾小球损伤模式已被分为不同的组织病理学组，以确定它们是否能够预测患者的长期预后。
我们分析了1981年4月至1988年12月期间参与一项重度狼疮性肾炎对照前瞻性治疗试验的85例患者的临床随访情况，平均随访时间为10年。患者根据1982年世界卫生组织狼疮性肾炎分类进行分类。
在随访期间[120±65（标准差）个月]，IV类（弥漫性增殖性肾小球肾炎）病变患者中有60%进入缓解期，相比之下，III类（≥50%，局灶性节段性肾小球肾炎）病变患者中只有38%进入缓解期，Vc类（≥50%）和Vd类病变患者中只有27%进入缓解期（P<0.05）。IV类病变患者10年肾脏存活率为75%，Vc类（≥50%）和Vd类病变患者为47%，III类（≥50%）病变患者为52%（P<0.05）。基于多变量分析，III类（≥50%）或Vc类（≥50%）和Vd类病变患者进展至终末期肾病的相对风险是IV类患者的2.9倍（P<0.01），而IV类患者进入缓解期的可能性是III类或Vc类和Vd类患者的8.2倍（P=0.0001）。
重度狼疮性肾炎患者的组织病理学分类为其长期预后提供了相关信息。
