Schwartz M M, Lan S P, Bernstein J, Hill G S, Holley K, Lewis E J
Central Laboratory, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
Kidney Int. 1992 Sep;42(3):743-8. doi: 10.1038/ki.1992.342.
The principal value of the renal biopsy in patients with SLE is as a therapeutic guide. Although semiquantitative indices of nephron loss (chronicity = CI) and acute potentially reversible inflammation (activity = AI) are reported by some to have separate values from traditional classifications of glomerular pathology as predictors of outcome and therapeutic guides, this point remains controversial. We have tested the predictive value of the AI and CI in a large group of patients with severe lupus glomerulonephritis (SLE GN) and a mean follow-up of 281 weeks +/- 116 (mean +/- SD). A total of 86 patients entered into the study of plasmapheresis in severe SLE GN by the Lupus Nephritis Collaborative Study Group, and long-term follow-up was available in 83. The predictive value of the AI and the CI was described over the entire range of cut-off points by the method of receiver operator characteristics (ROC). ROC analysis demonstrated that there was no level of either AI or CI that predicted the outcome of death or renal failure with sufficient sensitivity and specificity to be useful in the individual patient. The CI signifies renal damage and nephron loss, whereas the AI describes potentially reversible pathology. Neither the CI nor the AI taken by itself predicts individual outcomes of renal failure or death in patients with aggressively treated SLE GN. Since the indices fail to identify the patient whose disease will progress to renal failure, they are both insufficient as therapeutic guides and add little to the management of the patient with severe SLE GN.
肾活检对于系统性红斑狼疮（SLE）患者的主要价值在于其作为治疗指导。尽管一些人报告称，肾单位丢失的半定量指标（慢性程度=CI）和急性潜在可逆性炎症（活动程度=AI）与肾小球病理的传统分类在预测预后和治疗指导方面具有不同的价值，但这一点仍存在争议。我们在一大组重度狼疮性肾炎（SLE GN）患者中测试了AI和CI的预测价值，这些患者的平均随访时间为281周±116周（均值±标准差）。狼疮性肾炎协作研究组共有86例患者进入重度SLE GN血浆置换研究，其中83例有长期随访数据。通过受试者操作特征（ROC）方法描述了AI和CI在整个截断点范围内的预测价值。ROC分析表明，无论是AI还是CI，均不存在能以足够的敏感性和特异性预测死亡或肾衰竭结局从而对个体患者有用的水平。CI表示肾损伤和肾单位丢失，而AI描述的是潜在可逆性病理改变。对于积极治疗的SLE GN患者，单独的CI或AI均不能预测肾衰竭或死亡的个体结局。由于这些指标无法识别疾病将进展为肾衰竭的患者，因此它们作为治疗指导均不足，对重度SLE GN患者的管理帮助不大。
