Joo Young Bin, Kang Young Mo, Kim Hyoun-Ah, Suh Chang-Hee, Kim Tae-Jong, Park Yong-Wook, Lee Jisoo, Lee Joo-Hyun, Yoo Dae Hyun, Bae Sang-Cheol, Lee Hye-Soon, Bang So-Young
Department of Rheumatology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Division of Rheumatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
Int J Rheum Dis. 2018 May;21(5):1031-1039. doi: 10.1111/1756-185X.13274. Epub 2018 Apr 2.
To compare renal outcomes between cyclophosphamide (CYC) and mycophenolate mofetil (MMF), and attempt to identify a predictor of renal survival.
A total of 99 patients with class III-V lupus nephritis (LN) and treated with CYC or MMF were enrolled. The remission rate and predictors of poor renal outcomes in LN were assessed.
The mean age at LN diagnosis was 31.7 years. The baseline characteristics of the two groups were similar except for the chronicity index (3.1 ± 2.4 and 2.3 ± 0.8 for CYC and MMF, respectively, P = 0.007). The overall remission rate was 76.8% and 77.7% after 6 and 12 months, respectively, with no significant difference between the two groups at these time points. After a median follow-up of 36 months (interquartile range 12-60), eight (8.1%) patients had chronic kidney disease, four (4.1%) were dialyzed permanently, and seven (7.1%) suffered a relapse, with no significant difference in these final outcomes between the two groups. Adverse events included infection (CYC group), and rash and neutropenia (MMF group), with no significant difference in frequency between the two groups. Failure of induction therapy (hazards ratio [HR] = 10.626, P = 0.022) and the creatinine level at diagnosis of LN (HR = 8.397, P = 0.007) were significantly associated with renal survival adjusted for age at LN diagnosis, disease duration and proteinuria.
Response to current induction therapy for LN was favorable, and 6 months response following induction therapy was the most important predictor for renal survival.
比较环磷酰胺（CYC）和霉酚酸酯（MMF）的肾脏预后，并试图确定肾脏生存的预测因素。
共纳入99例接受CYC或MMF治疗的Ⅲ-Ⅴ型狼疮性肾炎（LN）患者。评估LN的缓解率和不良肾脏预后的预测因素。
LN诊断时的平均年龄为31.7岁。除慢性指数外，两组的基线特征相似（CYC组和MMF组分别为3.1±2.4和2.3±0.8，P = 0.007）。6个月和12个月后的总体缓解率分别为76.8%和77.7%，两组在这些时间点无显著差异。中位随访36个月（四分位间距12-60）后，8例（8.1%）患者患有慢性肾脏病，4例（4.1%）永久性透析，7例（7.1%）复发，两组在这些最终结局上无显著差异。不良事件包括感染（CYC组）、皮疹和中性粒细胞减少（MMF组），两组在发生频率上无显著差异。诱导治疗失败（风险比[HR]=10.626，P = 0.022）和LN诊断时的肌酐水平（HR = 8.397，P = 0.007）与经LN诊断时的年龄、病程和蛋白尿校正后的肾脏生存显著相关。
目前LN诱导治疗的反应良好，诱导治疗后6个月的反应是肾脏生存的最重要预测因素。
