Barber C E H, Geldenhuys L, Hanly J G
Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
Lupus. 2006;15(2):94-101. doi: 10.1191/0961203306lu2271oa.
The aim of this study was to describe the clinical course of patients with lupus nephritis (LN) who attain a sustained remission (SR) and identify predictors of SR. A retrospective study of patients with biopsy-proven LN were followed for up to 10 years. SR was defined as normal renal function, urine protein <0.5g/day, and an inactive urine sediment without significant immunosuppressive maintenance therapy for no less than three years. Control patients had LN but did not fulfill the criteria for SR. Data was collected at diagnosis of LN (T0), at onset of remission (T1), and at final follow-up (T2). A total of 35 patients were identified, 16 with a SR of LN and 19 controls, with a mean +/- SD follow-up of 126.4 +/- 8.5 months. Remission of LN was achieved following 37.7 +/- 6.8 months of therapy. At diagnosis (T0) the WHO classification of nephritis, activity and chronicity scores of renal biopsies were comparable in the two groups. At final follow-up (T2), the mean estimated creatinine clearance for the SR group was significantly higher than in controls (P = 0.009) and disease activity (SLEDAI scores) was lower (P = 0.002). Cumulative damage (SDI scores) in the SR group did not increase after patients entered remission (P = 0.250), whereas the mean SDI score in the control group increased significantly (P = 0.014) even when renal variables were excluded (P = 0.016). Multivariate analysis revealed that female gender (P = 0.023), older age (P = 0.034), higher nonrenal SLEDAI scores (P = 0.016) at the time of diagnosis of LN and absence of azathioprine (P = 0.010) were predictive of SR. It was concluded that remission of LN occurs in a substantial proportion of systemic lupus erythematosus (SLE) patients and may be sustained without maintenance immunosuppressive therapy. It is associated with a significantly slower accrual of both renal and non-renal damage over the ensuing seven years.
本研究的目的是描述达到持续缓解（SR）的狼疮性肾炎（LN）患者的临床病程，并确定SR的预测因素。对经活检证实为LN的患者进行了一项长达10年的回顾性研究。SR定义为肾功能正常、尿蛋白<0.5g/天、尿沉渣无活动且在不少于三年的时间内无需显著免疫抑制维持治疗。对照患者患有LN但未达到SR标准。在LN诊断时（T0）、缓解开始时（T1）和最终随访时（T2）收集数据。共确定了35例患者，16例LN达到SR，19例为对照，平均±标准差随访时间为126.4±8.5个月。治疗37.7±6.8个月后实现了LN缓解。在诊断时（T0），两组肾活检的WHO肾炎分类、活动度和慢性度评分相当。在最终随访时（T2），SR组的平均估计肌酐清除率显著高于对照组（P = 0.009），疾病活动度（SLEDAI评分）较低（P = 0.002）。SR组患者进入缓解期后累积损伤（SDI评分）未增加（P = 0.250），而对照组的平均SDI评分显著增加（P = 0.014），即使排除肾脏变量后也是如此（P = 0.016）。多变量分析显示，女性性别（P = 0.023）、年龄较大（P = 0.034）、LN诊断时非肾脏SLEDAI评分较高（P = 0.016）以及未使用硫唑嘌呤（P = 0.010）是SR的预测因素。得出的结论是，相当一部分系统性红斑狼疮（SLE）患者会出现LN缓解，且无需维持免疫抑制治疗即可维持。在随后的七年中，这与肾脏和非肾脏损伤的累积明显减缓相关。
