狼疮肾炎的临床和组织病理学特征及短期转归：100 例埃及患者的前瞻性研究。

Clinical and histopathological features and short-term outcomes of lupus nephritis: a prospective study of 100 Egyptian patients.

机构信息

Nephrology unit, Internal Medicine Department, The Ministry of Health and Population of Egypt, Egypt.

Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt.

出版信息

Lupus. 2020 Jul;29(8):993-1001. doi: 10.1177/0961203320928424. Epub 2020 Jun 3.

DOI:10.1177/0961203320928424

PMID:32493152

Abstract

OBJECTIVE

The short-term outcomes of lupus nephritis (LN) are variable and unpredictable among individuals. We aimed to evaluate the clinical and histopathological features and short-term renal outcomes in LN patients.

METHODS

This was a prospective cohort study carried out at nephrology and rheumatology units in Egypt between 2018 and 2019. A total of 100 patients with biopsy-proven LN were studied. Patients were evaluated for response after six months.

RESULTS

The female-to-male ratio was 8.1:1. About 70% of patients were hypertensive at disease onset, with rates for classes I, II, III, IV, V and VI LN being 1%, 7%, 20%, 53%, 14% and 6%, respectively. Among the immunosuppressive drugs used for induction, mycophenolate mofetil (MMF) represented the most commonly used (44%) followed by cyclophosphamide (CYC; 37%). After six months of follow-up, about two thirds of patients achieved remission. There was no significant difference in remission rate between MMF and CYC. On multivariate analysis, serum creatinine (SCr) at presentation was the most significant predictor of renal recovery. According to the receiver operating characteristic curve, the cut-off value of SCr was 1.6 mg/dL, with a sensitivity of 76% and specificity of 71% predicting renal recovery. Repeat renal biopsy was needed in 10 patients; class and treatment strategy changed in 40% and 70% of them, respectively.

CONCLUSION

Our findings in Egyptian LN patients compare favourably with most studies.

摘要

目的

狼疮肾炎（LN）患者的短期预后存在个体差异，难以预测。本研究旨在评估 LN 患者的临床和组织病理学特征及短期肾脏结局。

方法

这是一项在埃及肾病和风湿病科进行的前瞻性队列研究，共纳入 100 例经肾活检证实的 LN 患者。所有患者均接受了 6 个月的随访。

结果

男女比例为 8.1:1。约 70%的患者在发病时即出现高血压，其中 LN Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅵ级的发生率分别为 1%、7%、20%、53%、14%和 6%。诱导治疗中使用的免疫抑制剂中，吗替麦考酚酯（MMF）最常用（44%），其次是环磷酰胺（CYC；37%）。随访 6 个月后，约 2/3 的患者达到缓解。MMF 和 CYC 的缓解率无显著差异。多因素分析显示，就诊时的血清肌酐（SCr）是肾脏恢复的最显著预测因素。根据受试者工作特征曲线，SCr 的截断值为 1.6 mg/dL，其预测肾脏恢复的敏感性为 76%，特异性为 71%。10 例患者需要重复肾活检；其中 40%和 70%的患者分别改变了病理分级和治疗策略。