Tang Yi, Zhang XiaoYan, Ji Ling, Mi XuHua, Liu Fei, Yang LiChuan, Qin Wei
Division of Nephrology, West China Hospital of Sichuan University, 37# Guoxue Rd, Chengdu, Sichuan, China.
Int Urol Nephrol. 2015 Mar;47(3):513-20. doi: 10.1007/s11255-014-0903-y. Epub 2015 Jan 7.
The objective of this study was to assess clinicopathological characteristics and outcomes of lupus nephritis adult patients in China.
Clinicopathological features, treatment strategies, responses and outcome of 681 adult patients with biopsy-proved lupus nephritis were retrospectively analyzed.
Six hundred and eighty-one LN patients were included and followed up for 52.5 ± 14.1 months. Differences in age, disease duration, BP, proteinuria, serum albumin, creatinine, ANCA-positive ratio and SLEDAI scores were noticed between male and female patients, indicating severer disease in male patients. LN IV patients were much severer in systemic damage as well as immunological changes. During follow-up, 354 patients achieved CR, 107 patients achieved PR, 95 patients progressed to ESRD and 36 patients died. Prognosis and treatment response of patients with different histological types differ apparently. Renal outcome of patients with LN II and III was benign, while LN IV, V and VI was poor. Cyclophosphamide was effective in most patients. MMF and CNI could be used as salvage treatment. In multivariate analysis, BP, sCr, hypocomplementemia, severe proliferative lesion (LN IV or VI) and SLEDAI score were recognized as independent indicators of poor renal outcome. Infections, especially pulmonary fungus infection, thrombotic microangiopathy are the most common causes of death in LN patients.
Clinicopathological characteristics, treatment responses and long-term outcomes differ remarkably in LN patients with different gender and pathological subtypes. New indicators of poor renal outcome were identified. Infections and TTP were the most common causes of death in LN patients.
本研究的目的是评估中国成年狼疮性肾炎患者的临床病理特征及预后。
回顾性分析681例经活检证实为狼疮性肾炎的成年患者的临床病理特征、治疗策略、反应及预后。
纳入681例狼疮性肾炎患者，随访时间为52.5±14.1个月。男女患者在年龄、病程、血压、蛋白尿、血清白蛋白、肌酐、抗中性粒细胞胞浆抗体（ANCA）阳性率及系统性红斑狼疮疾病活动指数（SLEDAI）评分方面存在差异，提示男性患者病情更严重。狼疮性肾炎IV型患者的全身损害及免疫改变更为严重。随访期间，354例患者达到完全缓解（CR），107例患者达到部分缓解（PR），95例患者进展为终末期肾病（ESRD），36例患者死亡。不同组织学类型患者的预后及治疗反应明显不同。狼疮性肾炎II型和III型患者的肾脏预后良好，而IV型、V型和VI型患者预后较差。环磷酰胺对大多数患者有效。霉酚酸酯（MMF）和钙调神经磷酸酶抑制剂（CNI）可作为挽救治疗。多因素分析中，血压、血清肌酐（sCr）、低补体血症、严重增殖性病变（狼疮性肾炎IV型或VI型）及SLEDAI评分被认为是肾脏预后不良的独立指标。感染，尤其是肺部真菌感染、血栓性微血管病是狼疮性肾炎患者最常见的死亡原因。
不同性别及病理亚型的狼疮性肾炎患者在临床病理特征、治疗反应及长期预后方面存在显著差异。确定了肾脏预后不良的新指标。感染和血栓性血小板减少性紫癜（TTP）是狼疮性肾炎患者最常见的死亡原因。
