Hachiya Asaka, Karasawa Munetoshi, Imaizumi Takahiro, Kato Noritoshi, Katsuno Takayuki, Ishimoto Takuji, Kosugi Tomoki, Tsuboi Naotake, Maruyama Shoichi
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan.
Sci Rep. 2021 Jan 15;11(1):1525. doi: 10.1038/s41598-020-78972-1.
Lupus nephritis (LN) is a life-threatening complication of systemic lupus erythematosus. The 2003 pathological classification of LN was revised in 2016; it quantitatively evaluates the interstitium in addition to the glomeruli. We performed a retrospective multi-centre cohort study and investigated the utility of the 2016 classification-including the activity index (AI), chronicity index (CI), and each pathological component to predict complete remission or renal function decline, defined as 1.5-fold increase in serum creatinine levels-and compare with that of the 2003 classification. Ninety-one consecutive adult patients with first-onset class III/IV LN who were newly prescribed any immunosuppressants were enrolled and followed up for a median of 51 months from January 2004. Cox regression analysis demonstrated the subclasses based on the 2003 classification, which mainly evaluate glomerular lesions, were not associated with clinical outcomes. After adjustments for estimated glomerular filtration rate and urinary protein levels, higher CI and higher interstitial fibrosis and lower hyaline deposit scores were associated with renal functional decline. Similarly, higher CI and interstitial inflammation scores were associated with failure to achieve complete remission. Therefore, the 2016 classification can predict the clinical outcomes more precisely than the 2003 classification.
狼疮性肾炎（LN）是系统性红斑狼疮的一种危及生命的并发症。LN的2003年病理分类于2016年进行了修订；除肾小球外，还对间质进行了定量评估。我们进行了一项回顾性多中心队列研究，调查了2016年分类（包括活动指数（AI）、慢性指数（CI）以及每个病理成分）在预测完全缓解或肾功能下降（定义为血清肌酐水平升高1.5倍）方面的效用，并与2003年分类的效用进行比较。纳入了91例首次发病的III/IV级LN成年患者，这些患者新开始使用任何免疫抑制剂，并从2004年1月起进行了中位时间为51个月的随访。Cox回归分析表明，基于主要评估肾小球病变的2003年分类的亚类与临床结局无关。在对估计肾小球滤过率和尿蛋白水平进行调整后，较高的CI以及较高的间质纤维化和较低的透明沉积物评分与肾功能下降相关。同样，较高的CI和间质炎症评分与未实现完全缓解相关。因此，2016年分类比2003年分类能更准确地预测临床结局。
