简要报告：狼疮肾炎中的肾小管间质损伤：肾小管间质炎症和肾瘢痕形成相关因素的比较。
Brief Report: Tubulointerstitial Damage in Lupus Nephritis: A Comparison of the Factors Associated With Tubulointerstitial Inflammation and Renal Scarring.
机构信息
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Albert Einstein College of Medicine, Bronx, New York.
出版信息
Arthritis Rheumatol. 2018 Nov;70(11):1801-1806. doi: 10.1002/art.40575. Epub 2018 Sep 24.
OBJECTIVE
To characterize and compare the factors associated with tubulointerstitial inflammation (TII) and tubulointerstitial scarring, defined as interstitial fibrosis and/or tubular atrophy (IF/TA), in patients with lupus nephritis (LN).
METHODS
We identified systemic lupus erythematosus patients who had renal biopsy results consistent with LN between 2005 and 2017. Clinical data were collected from medical records. Multivariable logistic regression models were fitted to assess factors associated with TII and with IF/TA (moderate-to-severe versus none/mild).
RESULTS
Of 203 LN patients included, 41 (20%) had moderate-to-severe TII, 45 (22%) had moderate-to-severe IF/TA, and 21 (10%) had both. Multivariable logistic regression models showed that moderate-to-severe TII was associated with a shorter disease duration, African American race, proliferative LN, and an estimated glomerular filtration rate (eGFR) of <60 ml/minute/1.73 m at the time of biopsy. Hydroxychloroquine use was associated with significantly lower odds of moderate-to-severe TII (odds ratio 0.27 [95% confidence interval 0.10-0.70], P = 0.008). Similar to TII, factors associated with moderate-to-severe IF/TA included proliferative LN and eGFR <60 ml/minute/1.73 m at the time of biopsy. In addition, the presence of moderate-to-severe TII and older age was associated with moderate-to-severe IF/TA. None of the routinely available serologic markers-including anti-double-stranded DNA antibodies, anti-Ro/La antibodies, and low complement-were associated with tubulointerstitial damage.
CONCLUSION
The use of hydroxychloroquine was strongly associated with less inflammation, while the presence of TII, proliferative LN, and low eGFR were major determinants of tubulointerstitial scarring. Identifying modifiable factors is critical for the development of better preventive and therapeutic strategies with the goal of improving survival in patients with lupus-related kidney disease.
目的
描述并比较狼疮性肾炎（LN）患者中与小管间质性炎症（TII）和小管间质性瘢痕（定义为间质纤维化和/或肾小管萎缩（IF/TA））相关的因素。
方法
我们鉴定了 2005 年至 2017 年间肾活检结果符合 LN 的系统性红斑狼疮患者。从病历中收集临床数据。使用多变量逻辑回归模型评估与 TII 和 IF/TA（中重度与无/轻度）相关的因素。
结果
在 203 例 LN 患者中，41 例（20%）有中重度 TII，45 例（22%）有中重度 IF/TA，21 例（10%）两者均有。多变量逻辑回归模型显示，中重度 TII 与疾病持续时间较短、非裔美国人种族、增生性 LN 和活检时估计肾小球滤过率（eGFR）<60ml/min/1.73m 相关。羟氯喹的使用与 TII 中重度的可能性显著降低相关（比值比 0.27[95%置信区间 0.10-0.70]，P=0.008）。与 TII 相似，与中重度 IF/TA 相关的因素包括增生性 LN 和活检时 eGFR<60ml/min/1.73m。此外，TII 中重度存在和年龄较大与中重度 IF/TA 相关。常规可获得的血清学标志物（包括抗双链 DNA 抗体、抗 Ro/La 抗体和低补体）均与小管间质性损伤无关。
结论
羟氯喹的使用与炎症减轻强烈相关，而 TII、增生性 LN 和低 eGFR 的存在是小管间质性瘢痕形成的主要决定因素。确定可改变的因素对于制定更好的预防和治疗策略以改善狼疮相关肾病患者的生存率至关重要。
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