Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, South Korea.
Clin Rheumatol. 2011 Nov;30(11):1399-405. doi: 10.1007/s10067-011-1778-2. Epub 2011 May 20.
The objective of this study was to evaluate whether remission status after completion of induction therapy can be used to predict long-term renal outcomes, including renal relapse and chronic renal failure (CRF) in patients with proliferative lupus nephritis (LN). Of 201 patients with biopsy proven LN between 1998 and 2008, 117 were reviewed. Fifty nine (50.4%), 33 (28.2%), and 25 (21.4%) were assigned to the complete remission (CR), partial remission (PR), and non-remission (NR) groups, respectively. The 24-h urinary protein level was significantly lower in the CR than in the PR and NR groups. Induction therapy after the first detection of nephritis signs was initiated earlier in the CR than in the PR and NR groups. During follow-up, 36 (39.1%) patients suffered relapse. Multivariate analysis showed that longer latency period and a lack of CR were independent predictors of renal relapse. Seventeen (14.5%) patients experienced CRF. Multivariate analysis showed that higher baseline creatinine concentration and a lack of CR after induction therapy were independent predictors of CRF. We found that renal outcomes were related to remission status after 6 months induction therapy in patients with proliferative LN. Further, poor outcomes were associated with delayed intervention and higher creatinine concentration.
本研究旨在评估诱导治疗后缓解状态是否可用于预测增殖性狼疮肾炎（LN）患者的长期肾脏结局，包括肾脏复发和慢性肾衰竭（CRF）。在 1998 年至 2008 年间，对 201 例经活检证实的 LN 患者进行了回顾性分析，其中 117 例患者符合条件。59 例（50.4%）、33 例（28.2%）和 25 例（21.4%）患者分别归入完全缓解（CR）、部分缓解（PR）和未缓解（NR）组。CR 组的 24 小时尿蛋白水平明显低于 PR 和 NR 组。在 CR 组中，诱导治疗在首次检测到肾炎迹象后开始的时间更早。在随访期间，有 36 例（39.1%）患者发生复发。多变量分析表明，潜伏期较长和缺乏缓解是肾脏复发的独立预测因素。17 例（14.5%）患者发生 CRF。多变量分析表明，基线肌酐浓度较高和诱导治疗后缺乏缓解是 CRF 的独立预测因素。我们发现，增殖性 LN 患者在 6 个月诱导治疗后的缓解状态与肾脏结局相关。此外，较差的预后与延迟干预和较高的肌酐浓度有关。
