Hu W X, Chen Y H, Bao H, Liu Z Z, Wang S F, Zhang H T, Liu Z H
National Clinical Research Center of Kidney Diseases Jingling Hospital, Nanjing University School of Medicine, Nanjing, China.
National Clinical Research Center of Kidney Diseases Jingling Hospital, Nanjing University School of Medicine, Nanjing, China
Lupus. 2015 Sep;24(10):1067-75. doi: 10.1177/0961203315578766. Epub 2015 Mar 26.
Lupus podocytopathy is a newly recognized class of lupus nephritis characterized by extensive glomerular foot process effacement without capillary wall immune deposits. The treatment response and relapse of glucocorticoid with or without additional immunosuppressive agents has not been well investigated. In this study, 50 patients with lupus podocytopathy were included and received glucocorticoid alone (glucocorticoid monotherapy) or glucocorticoid plus additional immunosuppressive agents (combination therapy) for their induction or maintenance treatment regimens. The treatment response and relapse rate in the two groups were respectively analyzed. We found that the induction treatment with glucocorticoid monotherapy and combination therapy led to remission in 47 patients (94.0%) at 12 weeks treatment, with complete remission (CR) occurring in 38 patients (76.0%). The CR rate compared between glucocorticoid monotherapy and combination therapy showed no difference (76.7% vs 75.0%, p = 0.9), the median time to CR was four weeks (range: 2.0-6.0 weeks) in glucocorticoid monotherapy and 8.0 weeks (range: 3.7-12.0 weeks) in combination therapy (p = 0.076). Twenty-seven of 47 patients (57.4%) relapsed during maintenance, the relapse rate was much higher in the glucocorticoid monotherapy group than in the combination therapy group (89.5% vs 35.7%, p < 0.001), regardless of the induction regimens being glucocorticoid monotherapy or combination therapy. No patient developed end stage renal disease or died during follow-up for 6-125 months (median 62 months). In conclusion, the remission of lupus podocytopathy could be induced by glucocorticoid monotherapy or glucocorticoid plus other immunosuppressive agents, while the remission should be maintained by the combination regimen.
狼疮足细胞病是一种新认识的狼疮性肾炎类型，其特征为广泛的肾小球足突消失且无毛细血管壁免疫沉积物。单独使用糖皮质激素或联合其他免疫抑制剂治疗的反应及复发情况尚未得到充分研究。本研究纳入了50例狼疮足细胞病患者，他们在诱导或维持治疗方案中接受了单纯糖皮质激素治疗（糖皮质激素单药治疗）或糖皮质激素联合其他免疫抑制剂治疗（联合治疗）。分别分析了两组的治疗反应及复发率。我们发现，在治疗12周时，糖皮质激素单药治疗和联合治疗诱导47例患者（94.0%）病情缓解，其中38例患者（76.0%）完全缓解（CR）。糖皮质激素单药治疗和联合治疗的CR率比较无差异（76.7%对75.0%，p = 0.9），糖皮质激素单药治疗达到CR的中位时间为4周（范围：2.0 - 6.0周），联合治疗为8.0周（范围：3.7 - 12.0周）（p = 0.076）。47例患者中有27例（57.4%）在维持治疗期间复发，无论诱导方案是糖皮质激素单药治疗还是联合治疗，糖皮质激素单药治疗组的复发率均显著高于联合治疗组（89.5%对35.7%，p < 0.001）。在6 - 125个月（中位62个月）的随访期间，无患者发展为终末期肾病或死亡。总之，糖皮质激素单药治疗或糖皮质激素联合其他免疫抑制剂均可诱导狼疮足细胞病缓解，但联合方案更有利于维持缓解。
