Park Dong-Jin, Choi Sung-Eun, Xu Haimuzi, Kang Ji-Hyoun, Lee Kyung-Eun, Lee Ji Shin, Choi Yoo-Duk, Lee Shin-Seok
Departments of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea.
Pathology, Chonnam National University Medical School & Hospital, Gwangju, Korea.
Int J Rheum Dis. 2018 Feb;21(2):458-467. doi: 10.1111/1756-185X.13254. Epub 2018 Jan 5.
Renal responses to immunosuppressive agents in patients with lupus nephritis (LN) differ depending on ethnicity, follow-up duration, disease severity and treatment. Thus, we evaluated predictors of complete remission during the first year following immunosuppressive treatment in patients with LN.
We retrospectively reviewed 79 patients who underwent kidney biopsy prior to the start of induction treatment and who were subsequently treated with immunosuppressive drugs for at least 6 months and followed-up for more than a year. Complete remission (CR) was defined as inactive urinary sediment, a decrease in urinary protein to a creatinine ratio < 0.2, and normal or stable renal function. Multivariate analyses were performed using the logistic regression model to identify independent predictors of CR in LN patients.
After 1 year, renal response was achieved in 39 of 79 patients (49.4%) treated with immunosuppressive drugs. Intravenous cyclophosphamide was most commonly used as a treatment, followed in descending order of frequency by mycophenolate mofetil, azathioprine and cyclosporine. CR was associated with disease duration at the onset of LN, serum erythrocyte sedimentation rate, chronicity index on renal histology, glomerular sclerosis, tubular atrophy, interstitial fibrosis, and the use of hydroxychloroquine at the onset of LN. In multivariable regression analysis, glomerular sclerosis in the chronicity index was a significant predictor of complete remission in LN patients.
Our findings suggest that glomerular sclerosis in the chronicity index is an independent predictor of CR after the start of therapy in LN patients.
狼疮性肾炎（LN）患者对免疫抑制剂的肾脏反应因种族、随访时间、疾病严重程度和治疗方法而异。因此，我们评估了LN患者免疫抑制治疗后第一年完全缓解的预测因素。
我们回顾性分析了79例在诱导治疗开始前接受肾活检，随后接受免疫抑制药物治疗至少6个月且随访超过1年的患者。完全缓解（CR）定义为尿沉渣无活动、尿蛋白与肌酐比值降至<0.2，以及肾功能正常或稳定。使用逻辑回归模型进行多变量分析，以确定LN患者CR的独立预测因素。
1年后，79例接受免疫抑制药物治疗的患者中有39例（49.4%）实现了肾脏反应。静脉注射环磷酰胺是最常用的治疗方法，其次按使用频率从高到低依次为霉酚酸酯、硫唑嘌呤和环孢素。CR与LN发病时的病程、血清红细胞沉降率、肾脏组织学慢性指数、肾小球硬化、肾小管萎缩、间质纤维化以及LN发病时使用羟氯喹有关。在多变量回归分析中，慢性指数中的肾小球硬化是LN患者完全缓解的重要预测因素。
我们的研究结果表明，慢性指数中的肾小球硬化是LN患者开始治疗后CR的独立预测因素。
