Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
Nephrol Dial Transplant. 2012 Aug;27(8):3248-54. doi: 10.1093/ndt/gfs073. Epub 2012 Apr 20.
This study aimed to define the causes and associated risks of death compared with the local general population in Chinese patients with lupus nephritis in the recent era.
The records of all lupus nephritis patients followed in a single centre during 1968-2008 were reviewed. The causes of death were identified, the survival curves constructed and the standardized mortality ratios (SMRs) of potential risk factors were calculated with reference to the local general population.
Two hundred and thirty systemic lupus erythematosus patients with history of renal involvement (predominantly Class III/IV lupus nephritis with or without membranous features) were included. The follow-up was 4076.6 person-years (mean 17.7 ± 8.9 years). Twenty-four patients (10.4%) died, and 85% of the deaths occurred after 10 years of follow-up. The 5-, 10-, and 20-year survival rates were 98.6, 98.2 and 90.5%, respectively. The leading causes of death were infection (50.0%), cardiovascular disease (20.8%) and malignancy (12.5%). The renal survival rates at 5, 10 and 20 years were 99.5, 98.0 and 89.7%, respectively. The SMR in patients with renal involvement, end-stage renal disease (ESRD), malignancy or cardiovascular disease was 5.9, 26.1, 12.9 and 13.6, respectively.
Lupus nephritis is associated with a 6-fold increase in mortality compared with the general population. Lupus patients who develop ESRD have a 26-fold excess in the risk of death, which is more than twice the risk associated with malignancy or cardiovascular disease in these patients.
本研究旨在定义中国狼疮肾炎患者在近期时代与当地普通人群相比的死亡原因和相关风险。
回顾了 1968 年至 2008 年期间在单一中心接受治疗的所有狼疮肾炎患者的记录。确定了死亡原因，构建了生存曲线，并根据当地普通人群计算了潜在危险因素的标准化死亡率（SMR）。
共纳入 230 例有肾脏受累史的系统性红斑狼疮患者（主要为 III/IV 类狼疮肾炎，伴有或不伴有膜性特征）。随访时间为 4076.6 人年（平均 17.7 ± 8.9 年）。24 例患者（10.4%）死亡，85%的死亡发生在随访 10 年后。5 年、10 年和 20 年的生存率分别为 98.6%、98.2%和 90.5%。死亡的主要原因是感染（50.0%）、心血管疾病（20.8%）和恶性肿瘤（12.5%）。肾脏的 5 年、10 年和 20 年生存率分别为 99.5%、98.0%和 89.7%。有肾脏受累、终末期肾病（ESRD）、恶性肿瘤或心血管疾病的患者的 SMR 分别为 5.9、26.1、12.9 和 13.6。
与普通人群相比，狼疮肾炎患者的死亡率增加了 6 倍。发展为 ESRD 的狼疮患者的死亡风险增加了 26 倍，这是这些患者恶性肿瘤或心血管疾病相关风险的两倍多。
