Servicio de Reumatología, Hospital Hermanos Ameijeiras, La Habana, Cuba.
Servicio de Reumatología, Hospital Hermanos Ameijeiras, La Habana, Cuba.
Reumatol Clin (Engl Ed). 2022 Nov;18(9):513-517. doi: 10.1016/j.reumae.2021.08.003. Epub 2022 May 3.
To determine predictive factors for the development of lupus nephritis (LN) at the time of diagnosis of systemic lupus erythematosus (SLE).
A case-control study was carried out in a single center, 595 patients with a diagnosis of SLE without LN participated by clinical or laboratory parameters at diagnosis, they were followed for a mean of 6.8 (+4.5) years, conforming to the data of their files two groups: with NL (cases) and without NL (controls) at the end of the follow-up. Sociodemographic, clinical, serological, immunological variables and the albumin - globulin ratio (AGR), calculated as albumin/total protein-albumin at diagnosis, were compared between both groups. A univariate and multivariate analysis was carried out.
124 (20.8%) patients had LN during follow-up and 471 (79.2%) did not develop LN. Univariate analysis: variables significantly associated with the development of LN: smoking, oral ulcers, serositis, more than four classification criteria, abrupt onset of SLE, higher SLEDAI value, low AGR, low C3 levels, high anti-titers. -Double stranded DNA (anti-dc DNA), anti-nucleosomes and positivity of immunofluorescence in skin. Multivariate analysis: predictors of developing LN: elevated serum levels of anti-dc DNA (odds ratio (OR): 15.82; confidence interval (CI): 1.08-1.22, P < .0001), decrease in the C3 fraction (OR: 36.50; CI: 13.52-81.91, P < .0001) and the RAG < 1 (OR: 47.58; CI: 11.85-79.17, P < .0001).
The AGR below one was the greatest predictor of the appearance of LN, together with the low levels of C3 and high levels of anti-dc DNA antibodies, they may contribute to identifying patients with a higher risk of presenting LN.
确定系统性红斑狼疮（SLE）诊断时狼疮肾炎（LN）发展的预测因素。
在一家单中心进行了病例对照研究，共有 595 名无 LN 的 SLE 患者，通过诊断时的临床或实验室参数参与研究，中位随访时间为 6.8（+4.5）年，符合文件中两组数据：在随访结束时存在 NL（病例）和不存在 NL（对照）。比较两组之间的社会人口统计学、临床、血清学、免疫学变量以及白蛋白-球蛋白比值（AGR），该比值在诊断时计算为白蛋白/总蛋白-白蛋白。进行了单变量和多变量分析。
124 例（20.8%）患者在随访期间发生 LN，471 例（79.2%）未发生 LN。单变量分析：与 LN 发展显著相关的变量：吸烟、口腔溃疡、浆膜炎、超过四个分类标准、SLE 突然发作、SLEDAI 值较高、AGR 较低、C3 水平较低、抗-dsDNA 滴度较高。-双股 DNA（抗-dc DNA）、抗核小体和皮肤免疫荧光阳性。多变量分析：发生 LN 的预测因素：血清抗-dc DNA 水平升高（比值比（OR）：15.82；置信区间（CI）：1.08-1.22，P<0.0001）、C3 片段减少（OR：36.50；CI：13.52-81.91，P<0.0001）和 RAG<1（OR：47.58；CI：11.85-79.17，P<0.0001）。
AGR 低于 1 是 LN 出现的最大预测因素，与 C3 水平低和抗-dc DNA 抗体水平高一起，可能有助于识别具有更高出现 LN 风险的患者。
