新月体对增生性狼疮肾炎肾脏结局的影响。

The Crescentic Implication of Renal Outcomes in Proliferative Lupus Nephritis.

机构信息

From the Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, China.

F. Cai, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; F. Han, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; H. Wang, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; H. Han, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; J. Le, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology; L. Lan, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; Y. Xu, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; J. Chen, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine.

出版信息

J Rheumatol. 2018 Apr;45(4):513-520. doi: 10.3899/jrheum.170553. Epub 2018 Feb 15.

DOI:10.3899/jrheum.170553

PMID:29449502

Abstract

OBJECTIVE

To determine the association between crescents and renal outcomes, and the implications on therapeutic choices.

METHODS

There were 231 patients with biopsy-proven proliferative lupus nephritis (PLN) who were divided into 4 groups: 59 patients were in the noncrescent group (NC); 59 patients exclusively with segmental crescents were in the segmental crescent group (SC); patients with circumferential crescents were categorized into 2 groups according to the crescentic ratio (C1 had 64 patients with ≤ 25%, and C2 had 49 patients with > 25%). Their baseline laboratory tests, histopathological manifestations, and outcomes were compared.

RESULTS

Remission rates in NC, SC, C1, and C2 groups were 92.1%, 85.4%, 95.0%, and 76.1%, respectively. Fewer patients in the C2 group achieved complete remission than the other 3 groups. For longterm outcomes evaluated by serum creatinine (SCr) doubling or endstage renal disease (ESRD), the renal survival rate was lowest in the C2 group (p = 0.003). Including clinical and pathological variables in the Cox proportional hazard regression model separately, the multivariate analysis revealed that these were independent risk factors for SCr doubling or ESRD: baseline SCr (with every 1 mg/dl increase: HR = 1.834, 95% CI 1.465-2.296; p < 0.001), hemoglobin (with every 1 g/l increase: HR = 0.970, 95% CI 0.947-0.992; p = 0.009), the proportions of cellular crescents (with every 1% increase: HR = 1.040, 95% CI 1.015-1.066; p = 0.002) and fibrocellular crescents (with every 1% increase: HR = 1.085, 95% CI 1.013-1.163; p = 0.020), and severe renal tubular atrophy (HR = 5.348, 95% CI 1.278-22.373; p = 0.022).

CONCLUSION

PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.

摘要

目的

确定新月体与肾脏结局之间的关系，并探讨其对治疗选择的影响。

方法

共有 231 例经活检证实的增生性狼疮肾炎（PLN）患者被分为 4 组：59 例为无新月体组（NC）；59 例仅存在节段性新月体的患者为节段性新月体组（SC）；根据新月体比例，存在环状新月体的患者分为 2 组：C1 组 64 例，新月体比例≤25%；C2 组 49 例，新月体比例＞25%。比较各组患者的基线实验室检查、组织病理学表现和结局。

结果

NC、SC、C1 和 C2 组的缓解率分别为 92.1%、85.4%、95.0%和 76.1%。C2 组完全缓解的患者少于其他 3 组。用血清肌酐（SCr）翻倍或终末期肾病（ESRD）评估长期结局，C2 组的肾脏存活率最低（p=0.003）。将临床和病理变量分别纳入 Cox 比例风险回归模型进行多变量分析，结果显示，基线 SCr（每增加 1mg/dl：HR=1.834，95%CI 1.465-2.296；p＜0.001）、血红蛋白（每增加 1g/l：HR=0.970，95%CI 0.947-0.992；p=0.009）、细胞性新月体比例（每增加 1%：HR=1.040，95%CI 1.015-1.066；p=0.002）和纤维细胞性新月体比例（每增加 1%：HR=1.085，95%CI 1.013-1.163；p=0.020）以及严重肾小管萎缩（HR=5.348，95%CI 1.278-22.373；p=0.022）是 SCr 翻倍或 ESRD 的独立危险因素。