Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea.
Department of Pathology, Chonnam National University Medical School & Hospital, Gwangju, Korea.
Int J Rheum Dis. 2019 May;22(5):913-920. doi: 10.1111/1756-185X.13517. Epub 2019 Feb 27.
The aim of this study was to define clinical, histopathologic, and prognostic differences according to the presence of anti-ribosomal P antibody (anti-P) in Korean patients with biopsy-proven lupus nephritis (LN).
We studied 79 patients who underwent kidney biopsies prior to the start of induction treatment, and who were subsequently treated with immunosuppressive drugs for at least 6 months and followed-up for more than 6 months. Anti-P was measured by immunoblot analysis at the time of renal biopsy.
Of all patients, 35.4% were anti-P-positive. Such patients exhibited earlier LN onset, a higher Systemic Lupus Erythematosus Disease Activity Index 2000 score, and a higher estimated glomerular filtration rate at the time of renal biopsy, than did those without antibodies. Upon renal histopathological analysis, patients with anti-P exhibited less interstitial inflammation in terms of the activity index, less glomerular sclerosis, less tubular atrophy, and less interstitial fibrosis in terms of the chronicity index. Furthermore, anti-P was associated with lower chronicity scores. At a median follow-up time of 47 months, renal function was preserved in 27 of 28 patients who had anti-P, but only 38 of 51 patients without such antibodies did not progress to chronic renal disease. After multivariate logistic regression, we found that anti-P positivity was associated with a reduced rate of progression to chronic kidney disease after adjusting for gender, baseline creatinine, activity and chronicity score, and treatment response (odds ratio = 0.196, 95% CI: 0.039-0.989, P = 0.048).
Anti-P was associated with better histological findings, and anti-P-positive patients had better renal outcomes than those without anti-P.
本研究旨在根据韩国经活检证实的狼疮性肾炎（LN）患者抗核糖体 P 抗体（抗-P）的存在，定义其临床、组织病理学和预后差异。
我们研究了 79 名患者，他们在开始诱导治疗前接受了肾脏活检，随后接受了至少 6 个月的免疫抑制剂治疗，并随访了 6 个月以上。在进行肾活检时，通过免疫印迹分析来测量抗-P。
所有患者中有 35.4%为抗-P 阳性。与无抗体的患者相比，这些患者的 LN 发病更早，系统性红斑狼疮疾病活动指数 2000 评分更高，且在进行肾活检时估计肾小球滤过率更高。在肾组织病理学分析中，抗-P 患者的活动指数显示间质炎症程度较轻，肾小球硬化程度较轻，肾小管萎缩程度较轻，间质纤维化程度较轻。此外，抗-P 与较低的慢性评分相关。在中位数为 47 个月的随访中，在 28 名抗-P 阳性患者中有 27 名肾功能得以保留，但在 51 名无抗-P 抗体的患者中，只有 38 名未进展为慢性肾脏病。经过多变量逻辑回归分析，我们发现，在调整了性别、基线肌酐、活动和慢性评分以及治疗反应后，抗-P 阳性与进展为慢性肾脏病的风险降低相关（比值比=0.196，95%CI：0.039-0.989，P=0.048）。
抗-P 与更好的组织学发现相关，抗-P 阳性患者的肾脏预后优于无抗-P 患者。
