诱导治疗12周后未出现部分肾脏反应预示狼疮性肾炎Ⅲ或Ⅳ级患者肾脏反应不佳及全身损害累积。
Lack of partial renal response by 12 weeks after induction therapy predicts poor renal response and systemic damage accrual in lupus nephritis class III or IV.
作者信息
Hanaoka Hironari, Yamada Hidehiro, Kiyokawa Tomofumi, Iida Harunobu, Suzuki Takeshi, Yamasaki Yoshioki, Ooka Seido, Nagafuchi Hiroko, Okazaki Takahiro, Ichikawa Daisuke, Shirai Sayuri, Shibagaki Yugo, Koike Junki, Ozaki Shoichi
机构信息
Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan.
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan.
出版信息
Arthritis Res Ther. 2017 Jan 13;19(1):4. doi: 10.1186/s13075-016-1202-z.
BACKGROUND
Lupus nephritis class III or IV is associated with a poor prognosis for both patient and renal survival. Recommendations for the management of lupus nephritis have recently been established, and changing therapies is recommended for patients who do not respond adequately to induction therapy. However, it remains a major challenge to determine when to switch the treatment. In this study, we identified early prognostic factors capable of predicting poor renal outcome as well as overall damage accrual in patients with lupus nephritis class III or IV.
METHODS
Eighty patients with biopsy-proven lupus nephritis class III or IV were retrospectively recruited and divided into two groups: those with complete renal response (CR) or non-CR at 3 years after induction therapy. We investigated when clinical responses were obtained at each observational period from baseline to year 3. Clinical responses were divided into three groups: CR, partial renal response (PR), and non-PR. Furthermore, patients were assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and cumulative dose of corticosteroid for 3 years.
RESULTS
Forty-four patients with CR and thirty-six with non-CR were enrolled. The cumulative CR rate was 85.0%. PR rates of patients with CR were significantly higher than those with non-CR from week 12 (p < 0.01). We identified the achievement of PR at 12 weeks as an independent predictor (OR 3.57, p = 0.03) by multivariate analysis. We next divided all patients into two groups according to PR achievement at week 12. The cumulative CR rate of the patients who achieved PR at week 12 was significantly higher than that of those who did not (96.5% vs 69.2%, p < 0.001). Furthermore, a significantly higher SDI and cumulative dose of corticosteroid were seen in the patients who did not achieve PR at week 12 than in those who did, regardless of their CR status, at year 3.
CONCLUSIONS
Lack of PR at week 12 predicts a lower likelihood of achieving CR at 3 years and a higher SDI.
背景
III 型或 IV 型狼疮性肾炎与患者预后不良及肾脏存活情况不佳相关。近期已制定了狼疮性肾炎的管理建议，对于诱导治疗反应欠佳的患者，建议更换治疗方案。然而，确定何时更换治疗方案仍是一项重大挑战。在本研究中，我们确定了能够预测 III 型或 IV 型狼疮性肾炎患者肾脏预后不良以及整体损伤累积情况的早期预后因素。
方法
回顾性招募了 80 例经活检证实为 III 型或 IV 型狼疮性肾炎的患者，并将其分为两组：诱导治疗 3 年后达到完全肾脏缓解（CR）的患者和未达到 CR 的患者。我们调查了从基线到第 3 年各观察期获得临床反应的时间。临床反应分为三组：CR、部分肾脏缓解（PR）和非 PR。此外，使用系统性红斑狼疮国际协作临床组/美国风湿病学会损伤指数（SDI）和 3 年皮质类固醇累积剂量对患者进行评估。
结果
纳入了 44 例达到 CR 的患者和 36 例未达到 CR 的患者。累积 CR 率为 85.0%。达到 CR 的患者从第 12 周起 PR 率显著高于未达到 CR 的患者（p < 0.01）。通过多因素分析，我们确定第 12 周达到 PR 是一个独立预测因素（OR 3.57，p = 0.03）。接下来，我们根据第 12 周是否达到 PR 将所有患者分为两组。第 12 周达到 PR 的患者累积 CR 率显著高于未达到 PR 的患者（96.5% 对 69.2%，p < 0.001）。此外，在第 3 年时，无论 CR 状态如何，第 12 周未达到 PR 的患者的 SDI 和皮质类固醇累积剂量均显著高于达到 PR 的患者。
结论
第 12 周未达到 PR 预示着 3 年时达到 CR 的可能性较低且 SDI 较高。
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