Wang Hong, Ren Yi-le, Chang Jun, Gu Luo, Sun Ling-Yun
Department of Rheumatology and Immunology, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Nephrology and Rheumatology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Arch Rheumatol. 2017 Jul 25;33(1):17-25. doi: 10.5606/ArchRheumatol.2017.6127. eCollection 2018 Mar.
This study aims to conduct a meta-analysis to clarify the epidemiologic characteristics of biopsy-proven lupus nephritis (BPLN), including those relating to its prevalence and prognosis.
A literature search for relevant studies was conducted in the electronic databases of PubMed, Google Scholar, Embase, and Cochrane trial register. The following search terms were used for original articles published between January 1982 and April 2016: "lupus nephritis" or systemic lupus erythematosus ('SLE') or 'systemic lupus erythematous' and "pathology" or 'epidemiology' or prevalence or incidence. Pooled estimates with 95% confidence intervals were calculated.
Nineteen studies were included (mean age of SLE patients at renal biopsy: ~30 years). Of total BPLN patients, 85% were females. BPLN developed in 29% of SLE patients, and accounted for 60% of secondary glomerular diseases in renal biopsy databases. BPLN prevalence among SLE patients was higher in Saudi Arabia compared with pooled Europe/USA data (43% vs 26%, p<0.05). Pooled BPLN prevalence among secondary glomerular diseases patients was higher in Asian/Latin American countries than in Europe (63% vs 34%, p<0.05). Overall five-, 10- and 20-year survival rates of BPLN patients were 94%, 86%, and 71%, respectively, which were higher than those before 1995 (84%, 72%, and 52%, respectively) and lower than those after 1995 (96%, 89%, and 80%, respectively) (all p<0.05). Class IV nephritis, present in 40% of BPLN patients, was a risk factor for renal failure that contributed to poor prognosis.
Lupus nephritis is a common complication of young female patients with SLE, and the most prevalent etiology of secondary glomerular diseases. Attention should be paid to class IV nephritis due to its high frequency and association with poor prognosis.
本研究旨在进行一项荟萃分析，以阐明经活检证实的狼疮性肾炎（BPLN）的流行病学特征，包括其患病率和预后相关特征。
在PubMed、谷歌学术、Embase和Cochrane试验注册库的电子数据库中检索相关研究。对1982年1月至2016年4月发表的原始文章使用以下检索词：“狼疮性肾炎”或系统性红斑狼疮（'SLE'）或“系统性红斑狼疮”以及“病理学”或“流行病学”或患病率或发病率。计算95%置信区间的合并估计值。
纳入19项研究（肾活检时SLE患者的平均年龄：约30岁）。在所有BPLN患者中，85%为女性。29%的SLE患者发生BPLN，在肾活检数据库中占继发性肾小球疾病的60%。与欧洲/美国汇总数据相比，沙特阿拉伯SLE患者中BPLN的患病率更高（43%对26%，p<0.05）。亚洲/拉丁美洲国家继发性肾小球疾病患者中BPLN的合并患病率高于欧洲（63%对34%，p<0.05）。BPLN患者的总体5年、10年和20年生存率分别为94%、86%和71%，高于1995年之前（分别为84%、72%和52%）且低于1995年之后（分别为96%、89%和80%）（所有p<0.05）。IV型肾炎存在于40%的BPLN患者中，是肾衰竭的危险因素，导致预后不良。
狼疮性肾炎是年轻女性SLE患者的常见并发症，也是继发性肾小球疾病最常见的病因。由于IV型肾炎的高发生率及其与不良预后的关联，应予以关注。
