Smith E M D, Yin P, Jorgensen A L, Beresford M W
1 Department of Women's & Children's Health, University of Liverpool, UK Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK.
2 Research Center for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
Lupus. 2018 Nov;27(13):2020-2028. doi: 10.1177/0961203318801526. Epub 2018 Sep 23.
Juvenile-onset systemic lupus erythematosus (JSLE) patients may develop lupus nephritis (LN) during their initial presentation, or later in their disease. This study aimed to assess whether clinical/demographic factors characterize patients with LN within the United Kingdom JSLE Cohort Study, and whether such factors predict subsequent LN development.
Univariate logistic regression modelling compared clinical/demographic factors in patients with and without LN at baseline. For those who subsequently developed LN, Cox proportional-hazard modelling was used to test the association between such factors and time to LN development. Covariates with p < 0.2 univariately were included within a multiple-regression model.
A total of 121/331 (37%) patients presented with active LN at baseline, with first American College of Rheumatology (ACR) score ( p < 2.0 × 10), severe hypertension ( p = 0.0006), proteinuria ( p < 2.0 × 10), creatinine ( p = 1.0 × 10), erythrocyte sedimentation rate ( p = 1.0 × 10), neutrophils ( p < 2.0 × 10), complement 3 (C3) ( p = 4.0 × 10) and ethnicity ( p = 3.0 × 10) differing between those with and without LN. Of the 210 individuals without active LN at baseline, 13 patients had a single visit and were excluded from further analysis. Thirty-four of 197 (17%) developed LN after a median of 2.04 years (interquartile range, 0.8-3.7), with higher ACR scores ( p = 0.014 , hazard ratio (HR) = 1.45, 95% confidence interval (CI) = 1.08-1.95) and lower C3 levels ( p = 0.0082 , HR = 0.27, 95% CI = 0.10-0.68) demonstrated as predictors of subsequent LN.
Clinical and demographic factors can help to characterize patients at increased risk of LN.
青少年起病的系统性红斑狼疮（JSLE）患者在初次就诊时或疾病后期可能会发展为狼疮性肾炎（LN）。本研究旨在评估在英国JSLE队列研究中，临床/人口统计学因素是否可用于表征LN患者，以及这些因素是否能预测后续LN的发生。
采用单因素逻辑回归模型比较基线时患有和未患有LN的患者的临床/人口统计学因素。对于随后发展为LN的患者，使用Cox比例风险模型来检验这些因素与LN发生时间之间的关联。单因素分析中p<0.2的协变量被纳入多元回归模型。
共有121/331（37%）的患者在基线时出现活动性LN，患有和未患有LN的患者之间，首次美国风湿病学会（ACR）评分（p<2.0×10）、重度高血压（p = 0.0006）蛋白尿（p<2.0×10）、肌酐（p = 1.0×10）、红细胞沉降率（p = 1.0×10）、中性粒细胞（p<2.0×10）、补体3（C3）（p = 4.0×10）和种族（p = 3.0×10）存在差异。在基线时无活动性LN的210名个体中，13名患者仅就诊一次，被排除在进一步分析之外。197名患者中有34名（17%）在中位时间2.04年（四分位间距，0.8 - 3.7）后发展为LN，较高的ACR评分（p = 0.014，风险比（HR）= 1.45，95%置信区间（CI）= 1.08 - 1.95）和较低的C3水平（p = 0.0082，HR = 0.27，95%CI = 0.10 - 0.68）被证明是后续LN的预测因素。
临床和人口统计学因素有助于表征LN风险增加的患者。
