Mak A, Mok C C, Chu W P, To C H, Wong S N, Au T C
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Hong Kong SAR.
Lupus. 2007;16(1):28-34. doi: 10.1177/0961203306074469.
The objective of this study was to compare the frequency and severity of renal damage in systemic lupus erythematosus (SLE) with regard to the age of disease onset. Among 287 patients with new onset SLE diagnosed between 1991 and 2003 in our hospital, we identified those who fulfilled the American College of Rheumatology (ACR) criteria for renal involvement. Patients were categorized into childhood (age < 16 [corrected] years), adult (between 16 and 50 years) or late onset ( > or = 50 years) SLE. Clinical presentation of renal disease and cumulative renal damage as assessed by the renal domain of the Systemic Lupus International Collaborating Clinics/ACR damage index (SDI) were compared. A linear regression model was constructed to study the effect of age on renal damage. One-hundred and forty-nine patients were studied (134 women and 15 men), including 28 childhood, 107 adult and 14 late onset SLE patients. The mean age of SLE onset was 29.7 +/- 14 years. The prevalence of renal disease was 53% in childhood onset, 50% in adult onset and 58% in late onset SLE patients (P = 0.66). At renal disease presentation, late onset SLE patients had significantly lower creatinine clearance and were more likely to be hypertensive. Histological classes of nephritis and initial treatment response, however, did not differ significantly among the patients. After a mean observation of 80.3 months, 32 (21%) patients developed renal damage (renal SDI > or = 1). Late onset SLE patients had accrued more renal damage than the others. In a multiple regression model, age was not a significant determinant of renal damage after adjustment for baseline renal parameters, duration of renal disease, use of cyclophosphamide and initial treatment response. We concluded that the prevalence of renal disease was similar among SLE patients of different ages of onset. Late onset SLE patients had accrued more renal damage but age did not correlate with renal damage after adjustment for various clinical parameters.
本研究的目的是比较系统性红斑狼疮（SLE）患者中，不同发病年龄的肾脏损害频率及严重程度。在我院1991年至2003年间诊断的287例新发SLE患者中，我们确定了符合美国风湿病学会（ACR）肾脏受累标准的患者。患者被分为儿童期（年龄<16[校正后]岁）、成年期（16至50岁）或晚发期（≥50岁）SLE。比较了肾脏疾病的临床表现以及通过系统性红斑狼疮国际协作临床研究/ACR损伤指数（SDI）的肾脏领域评估的累积肾脏损害。构建线性回归模型以研究年龄对肾脏损害的影响。共研究了149例患者（134例女性和15例男性），包括28例儿童期、107例成年期和14例晚发期SLE患者。SLE发病的平均年龄为29.7±14岁。儿童期发病的SLE患者肾脏疾病患病率为53%，成年期发病为50%，晚发期发病为58%（P = 0.66）。在肾脏疾病表现时，晚发期SLE患者的肌酐清除率显著较低，且更易患高血压。然而，患者之间的肾炎组织学类型和初始治疗反应并无显著差异。经过平均80.3个月的观察，32例（21%）患者出现肾脏损害（肾脏SDI≥1）。晚发期SLE患者累积的肾脏损害比其他患者更多。在多元回归模型中，在对基线肾脏参数、肾脏疾病持续时间、环磷酰胺的使用和初始治疗反应进行调整后，年龄并非肾脏损害的显著决定因素。我们得出结论，不同发病年龄的SLE患者中肾脏疾病的患病率相似。晚发期SLE患者累积了更多的肾脏损害，但在对各种临床参数进行调整后，年龄与肾脏损害并无相关性。
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