Li Qiu-Yu, Yu Feng, Zhou Fu-De, Zhao Ming-Hui
From the Department of Medicine, Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China (Q-YL, FY, F-DZ, M-HZ); Department of Nephrology, Peking University International Hospital (FY); and Peking-Tsinghua Center for Life Sciences, Beijing, PR China (M-HZ).
Medicine (Baltimore). 2016 May;95(18):e3595. doi: 10.1097/MD.0000000000003595.
The aim of this study was to evaluate the efficacy of plasmapheresis in patients with lupus nephritis-combined thrombotic microangiopathy (TMA) in a Chinese cohort.Clinical and therapeutic data of patients with lupus nephritis-combined TMA were collected retrospectively. A comparison between those with and without plasmapheresis was performed.Seventy patients with renal biopsy-proven TMA in lupus nephritis were treated with conventional combined corticosteroid and immunosuppressive agents as induction therapy, 9 of the 70 patients received additional plasmapheresis. The plasmapheresis group presented with more severe SLE and renal activity indices, including a significant higher ratio of neurologic disorder (P = 0.025), lower level of platelet count (P = 0.009), higher value of serum creatinine (P = 0.038), higher percentage of anti-cardiolipin antibodies positive (P = 0.001), and higher Systemic Lupus Erythematosus Disease Activity Index scores (P = 0.012), than that of the nonplasmapheresis group. However, the plasmapheresis group had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P = 0.03). As the baseline data were significantly different between the 2 groups, the propensity score match was further designed to avoid retrospective bias. After re-analysis, the plasmapheresis group still had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P = 0.018). More importantly, the plasmapheresis group had significant less composite endpoints than that of the nonplasmapheresis group (P = 0.005).Our study suggested that additional plasmapheresis on conventional induction therapy may benefit patients with lupus nephritis-combined TMA, which warrants further explorations.
本研究旨在评估在中国队列中，血浆置换术对狼疮性肾炎合并血栓性微血管病（TMA）患者的疗效。回顾性收集狼疮性肾炎合并TMA患者的临床和治疗数据，并对接受和未接受血浆置换术的患者进行比较。70例经肾活检证实为狼疮性肾炎合并TMA的患者接受了传统的糖皮质激素和免疫抑制剂联合诱导治疗，其中9例患者额外接受了血浆置换术。血浆置换术组的系统性红斑狼疮（SLE）和肾脏活动指标更为严重，包括神经功能障碍比例显著更高（P = 0.025）、血小板计数水平更低（P = 0.009）、血清肌酐值更高（P = 0.038）、抗心磷脂抗体阳性百分比更高（P = 0.001）以及系统性红斑狼疮疾病活动指数评分更高（P = 0.012）。然而，血浆置换术组的缓解率显著高于未进行血浆置换术的组，治疗失败率更低（P = 0.03）。由于两组的基线数据存在显著差异，进一步设计了倾向评分匹配以避免回顾性偏倚。重新分析后，血浆置换术组的缓解率仍然显著高于未进行血浆置换术的组，治疗失败率更低（P = 0.018）。更重要的是，血浆置换术组的复合终点显著少于未进行血浆置换术的组（P = 0.005）。我们的研究表明，在传统诱导治疗基础上额外进行血浆置换术可能使狼疮性肾炎合并TMA患者受益，这值得进一步探索。
