预测系统性红斑狼疮患者 eGFR 下降开始的因素。
Predictors of the start of declining eGFR in patients with systemic lupus erythematosus.
机构信息
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Departments of Computer Science & Statistics, Whiting School of Engineering, Baltimore, MD, USA.
出版信息
Lupus. 2021 Jan;30(1):15-24. doi: 10.1177/0961203320966393. Epub 2020 Oct 28.
OBJECTIVE
To characterize the longitudinal trajectory of estimated glomerular filtration rate (eGFR) in patients with systemic lupus erythematosus (SLE) and identify predictors of the change in eGFR trajectory.
METHODS
The longitudinal eGFR levels of patients in the Hopkins Lupus Cohort were modelled by piecewise linear regression to evaluate the slope of different line segments. The slopes were classified into declining (≤-4 mL/min/1.73 m per year), stable (-4 to 4 mL/min/1.73 m per year), and increasing (≥4 mL/min/1.73 m per year) states. The transition rate between states and the impact of clinical parameters were estimated by a Markov model.
RESULTS
The analysis was based on 494 SLE patients. At a mean follow-up of 8.8 years, 347 (70.2%), 107 (21.7%), 33 (6.7%), and 7 (1.4%) patients had zero, one, two, and three state transitions, respectively. In patients with no transition, 37 (10.7%), 308 (88.8%), and 2 (0.6%) were in declining, stable, and increasing state, respectively. In patients with one transition, 43 (40.2%) changed from declining to stable state while 29 (27.1%) changed from stable to declining state. When patients were in a non-declining GFR state, those who were younger and African Americans were more likely to transition to a declining GFR state. In adjusted analyses, high blood pressure, C4 and low hematocrit were associated with change from non-declining to declining state. High urine protein-to-creatinine ratio also tended to be associated with change from non-declining to declining state. African American patients were less likely to move from declining to non-declining state. Use of prednisone was associated with change from declining to non-declining state.
CONCLUSIONS
Patients with high blood pressure, low complement C4, low haematocrit, and high urine protein-to-creatinine ratio are more likely to have a declining eGFR trajectory, while the use of prednisone stabilizes the declining eGFR trajectory.
目的
描述系统性红斑狼疮（SLE）患者估算肾小球滤过率（eGFR）的纵向变化轨迹，并确定 eGFR 变化轨迹的预测因素。
方法
通过分段线性回归对霍普金斯狼疮队列患者的纵向 eGFR 水平进行建模，以评估不同线段的斜率。将斜率分为下降（≤-4ml/min/1.73m/年）、稳定（-4 至 4ml/min/1.73m/年）和增加（≥4ml/min/1.73m/年）状态。通过马尔可夫模型估计状态之间的转移率和临床参数的影响。
结果
该分析基于 494 例 SLE 患者。在平均 8.8 年的随访中，分别有 347（70.2%）、107（21.7%）、33（6.7%）和 7（1.4%）例患者的状态分别为零、一、二和三次。在没有状态转变的患者中，分别有 37（10.7%）、308（88.8%）和 2（0.6%）例患者的状态为下降、稳定和增加。在有一次状态转变的患者中，有 43（40.2%）例从下降状态转变为稳定状态，而有 29（27.1%）例从稳定状态转变为下降状态。当患者处于非下降的 GFR 状态时，年轻和非裔美国人更有可能转变为下降的 GFR 状态。在调整分析中，高血压、C4 低和低红细胞压积与从不下降状态转变为下降状态相关。高尿蛋白/肌酐比也与从不下降状态转变为下降状态相关。非裔美国人患者从下降状态转变为非下降状态的可能性较小。使用泼尼松与从不下降状态转变为下降状态相关。
结论
高血压、低补体 C4、低红细胞压积和高尿蛋白/肌酐比的患者更有可能出现下降的 eGFR 轨迹，而使用泼尼松可稳定下降的 eGFR 轨迹。
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