Zakharova Elena V, Makarova Tatiana A, Zvonova Elena V, Anilina Alina M, Stolyarevich Ekaterina S
Nephrology Department, City Botkin Memorial Hospital, Moscow, Russia; Nephrology Chair, State University of Medicine and Dentistry, Moscow, Russia.
Nephrology Department, City Botkin Memorial Hospital, Moscow, Russia.
Biomed Res Int. 2016;2016:7407919. doi: 10.1155/2016/7407919. Epub 2016 Dec 5.
Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival significantly differ for subgroups that achieved complete or partial renal response and nonresponders: patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58% versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period sustained complete renal response; however, only 9 of them had 0 disease activity according to SELENA SLEDAI scale, while 13 patients had scores 2-4 due to the serological abnormalities only. We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and can be used in agreement with International Guidelines until the evidence for biological treatments benefits becomes available; (2) complete and even partial renal response have positive prognostic value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the validity of complete renal response in SLE is questioned by the absence of conventional definition of SLE remission.
狼疮性肾炎是系统性红斑狼疮最严重的特征之一，决定着治疗方式和预后。我们的回顾性研究纳入了178例狼疮性肾炎患者，这些患者在23年中接受治疗，初始方案大多以环磷酰胺为基础，随后使用硫唑嘌呤或霉酚酸，结果显示肾脏缓解率为84.8%，复发率为19.2%，15年患者生存率为78.7%，肾脏生存率为76.3%，且损害累积程度较低。达到完全或部分肾脏缓解的亚组与未缓解者在患者和肾脏生存率方面存在显著差异：患者15年生存率分别为95%、65%和35%；肾脏15年生存率分别为100%、58%和0%。在研究期末评估的患者中，51%（47例中的24例）维持了完全肾脏缓解；然而，根据SELENA SLEDAI量表，其中只有9例疾病活动度为0，而13例患者仅因血清学异常评分为2 - 4分。我们得出以下结论：（1）以环磷酰胺起始治疗，随后使用硫唑嘌呤是有效的，在有生物学治疗益处的证据出现之前，可按照国际指南使用；（2）完全甚至部分肾脏缓解具有积极的预后价值，未达到肾脏缓解会对肾脏和患者生存产生负面影响；（3）由于缺乏系统性红斑狼疮缓解的传统定义，系统性红斑狼疮中完全肾脏缓解的有效性受到质疑。
