Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Arthritis Care Res (Hoboken). 2012 May;64(5):713-20. doi: 10.1002/acr.21597.
There are sparse data on outcome of lupus nephritis from developing countries. This study looks at outcome in Asian Indians.
This retrospective study included patients at a single center over 20 years. Patients were treated as per standard protocols. The primary outcome measure was chronic renal failure or death; the secondary outcome was end-stage renal disease or death. The worst-case scenario was also calculated, considering those lost to followup in the first year as events. Kaplan-Meier survival curves and the log rank test were used for survival analysis. Data are shown as the mean ± SD.
We included 188 patients with lupus nephritis, with a female:male ratio of 11:1, a mean ± SD age at onset of 23.6 ± 10.5 years, and a median followup time of 6 years (interquartile range 3-9 years). Of 136 patients with a biopsy sample, the distribution was as follows: class II in 22, class III in 36, class IV in 61, class V in 16, and class VI in 1. Survival with normal renal function was 84%, 69%, and 57% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 77%, 63%, and 51%, respectively. There was no difference in survival by histologic class; however, nonbiopsied patients had lower survival. Renal survival was 91%, 81%, and 76% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 79%, 70%, and 66%, respectively. Risk factors for poor outcome were low C3, hematuria, hypertension, creatinine, lack of remission, and occurrence of major infection. There was a high rate of major infections of 42.3%, with tuberculosis at 11.5%. Infections caused one-half of all deaths.
The outcome of lupus nephritis in Asian Indians with standard immunosuppressive regimens is reasonable, but immunosuppression is associated with a high rate of infection.
发展中国家有关狼疮肾炎结局的数据较为匮乏。本研究观察了亚洲印第安人的结局。
这是一项单中心 20 年的回顾性研究，纳入了患者。患者按标准方案进行治疗。主要结局测量指标为慢性肾衰竭或死亡；次要结局为终末期肾病或死亡。也计算了最差情况，即考虑到第 1 年失访的患者作为事件。使用 Kaplan-Meier 生存曲线和对数秩检验进行生存分析。数据以均数±标准差表示。
共纳入 188 例狼疮肾炎患者，男女比例为 11:1，发病时的平均年龄±标准差为 23.6±10.5 岁，中位随访时间为 6 年（四分位间距 3-9 年）。在 136 例有活检样本的患者中，分布如下：Ⅱ级 22 例，Ⅲ级 36 例，Ⅳ级 61 例，Ⅴ级 16 例，Ⅵ级 1 例。正常肾功能的生存情况分别为 5、10 和 15 年时的 84%、69%和 57%；最差情况下分别为 77%、63%和 51%。组织学分类对生存无影响；然而，未行活检的患者生存率较低。肾脏生存情况分别为 5、10 和 15 年时的 91%、81%和 76%；最差情况下分别为 79%、70%和 66%。预后不良的危险因素包括低 C3、血尿、高血压、肌酐、缓解不佳和发生重大感染。重大感染发生率高达 42.3%，其中结核病占 11.5%。感染导致一半的死亡。
亚洲印第安人采用标准免疫抑制方案治疗狼疮肾炎的结局尚可，但免疫抑制与高感染率相关。
