de Castro W P, Morales J V, Wagner M B, Graudenz M, Edelweiss M I, Gonçalves L F
Post-Graduation Program in Medical Sciences: Nephrology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Brazil.
Lupus. 2007;16(9):724-30. doi: 10.1177/0961203307081114.
Hypertension and ethnicity are important prognostic factors in evolution of lupus nephritis. A cohort of 75 patients with lupus nephritis treated with cyclophosphamide was conducted to investigate the evolution of creatinine levels between Caucasians and Afro-descendants. A multiple linear model was used to evaluate the combined effects of ethnicity and hypertension over delta creatinine controlling confounders. Sample characteristics were: 85% females; mean (+/-SD) age of 33.6 +/- 12.0 years; 77% Caucasians; 40% hypertensive at renal biopsy; 91% WHO class IV; mean basal creatinine: 1.5 +/- 1.3 mg/dL; mean final creatinine: 2.1 +/- 2.5 mg/dL; 40% anaemia; proteinuria: 5.4 +/- 4.8 g/day. Comparing Caucasians and Afro-descendants, it was found: 28.1% versus 72.2% for hypertension (P = 0.002); 31.6% versus 66.7% for anaemia (P = 0.018); 5.9 +/- 5.0 versus 3.8 +/- 4.0. g/day (P = 0.02) for proteinuria. Other comparisons including basal creatinine did not reach statistical significance. Comparing outcomes between Caucasians and Afro-descendants, it was found: 10.5% versus 22.2% for doubling of creatinine (P = 0.24); 0.41 +/- 2.03 versus 1.05 +/- 2.41 for delta creatinine ( P = 0.29); 8.8% versus 22.2% for haemodialysis (P = 0.21) and 3.5% versus 5.6% for death (P = 0.99). Analysing delta creatinine with multiple linear regression showed that hypertension had a significant overall effect (b = 0.80; SE = 0.32; P = 0.015), ethnicity alone was not significant (b = 0.35; SE = 0.29; P = 0.228); however, the effect of hypertension on delta creatinine was more intense among Afro-descendants than among Caucasians (interaction term b = - 0.83; SE = 0.37; P = 0.027). Afro-descendants lupus patients experience worst prognosis of renal function probably due to the effect of hypertension and not ethnicity per se.
高血压和种族是狼疮性肾炎病情发展中的重要预后因素。对75例接受环磷酰胺治疗的狼疮性肾炎患者进行了一项队列研究，以调查白种人和非洲裔后代之间肌酐水平的变化情况。采用多元线性模型来评估种族和高血压对肌酐变化值（delta creatinine）的综合影响，并对混杂因素进行控制。样本特征如下：女性占85%；平均（±标准差）年龄为33.6±12.0岁；77%为白种人；肾活检时40%患有高血压；91%为世界卫生组织（WHO）IV级；平均基础肌酐：1.5±1.3mg/dL；平均最终肌酐：2.1±2.5mg/dL；40%患有贫血；蛋白尿：5.4±4.8g/天。比较白种人和非洲裔后代发现：高血压患病率分别为28.1%和72.2%（P = 0.002）；贫血患病率分别为31.6%和66.7%（P = 0.018）；蛋白尿分别为5.9±5.0和3.8±4.0g/天（P = 0.02）。包括基础肌酐在内的其他比较未达到统计学显著性。比较白种人和非洲裔后代的结局发现：肌酐翻倍的比例分别为10.5%和22.2%（P = 0.24）；肌酐变化值分别为0.41±2.03和1.05±2.41（P = 0.29）；血液透析的比例分别为8.8%和22.2%（P = 0.21）；死亡比例分别为3.5%和5.6%（P = 0.99）。通过多元线性回归分析肌酐变化值发现，高血压具有显著的总体影响（b = 0.80；标准误 = 0.32；P = 0.015），单独的种族因素不显著（b = 0.35；标准误 = 0.29；P = 0.228）；然而高血压对肌酐变化值的影响在非洲裔后代中比在白种人中更为强烈（交互项b = - 0.83；标准误 = 0.37；P = 0.027）。非洲裔狼疮患者肾功能预后可能更差，这可能是由于高血压的影响，而非种族本身的原因。
