Suppr
超能文献

增生性狼疮肾炎的缓解和长期结局：来自沙特阿拉伯的 96 例患者的回顾性研究。

Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia.

机构信息

1 Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.

2 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.

出版信息

Lupus. 2019 Aug;28(9):1082-1090. doi: 10.1177/0961203319860584. Epub 2019 Jul 11.

DOI:10.1177/0961203319860584

PMID:31296138

Abstract

BACKGROUND

Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East.

METHODS

An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed.

RESULTS

Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44-29.39, = 0.015). Based on Kaplan-Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, = 0.001) and partial remission (89.7 versus 77.6%, = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up.

CONCLUSION

Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.

摘要

背景

关于中东地区增殖性狼疮肾炎（PLN）短期缓解率及其对长期结局的影响，目前仅有少量数据。

方法

本研究开展了一项观察性研究，共纳入来自四家医院的 96 例经活检证实的局灶性或弥漫性增殖性狼疮肾炎（PLN）成年患者。收集并分析诱导缓解、缓解及长期结局的数据。

结果

在 96 例经活检证实的 PLN 患者中（中位年龄 27（IQR：21，34）岁，85%为女性，确诊前系统性红斑狼疮（SLE）的中位病程为 27（IQR：11，55）个月），67%的患者在 6 个月时达到缓解（缓解率为 0.67；95%CI 0.57，0.76）。45/96 例（47%）患者使用霉酚酸酯（MMF）、41/95 例（43%）患者使用环磷酰胺（CYC）、10/96 例（10%）患者使用其他药物。近年来，MMF 作为诱导缓解药物的选择有所增加。在基线特征中，仅发现组织学活动与缓解显著相关，活动病变比活动/慢性病变和慢性病变更有可能缓解（优势比 6.5，95%CI 1.44-29.39， = 0.015）。基于 Kaplan-Meier 分析，无血清肌酐翻倍的 5 年肾脏存活率为 73.8%。与完全缓解患者相比，无缓解（89.7 比 43%， = 0.001）和部分缓解（89.7 比 77.6%， = 0.256）患者的长期肾脏存活率较低。在中位随访 48 个月时，血清肌酐翻倍、透析、复发和死亡的累积发生率分别为 23%、11%、10%和 5%。