迟发性狼疮性肾炎的长期肾脏预后及病理特征

Long-Term Kidney Prognosis and Pathological Characteristics of Late-Onset Lupus Nephritis.

作者信息

Tian Na, Zhou Qian, Yin PeiRan, Chen WenFang, Hong LingYao, Luo QiMei, Chen MengHua, Yu XueQing, Chen Wei

机构信息

Key Laboratory of National Health Commission, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.

Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China.

出版信息

Front Med (Lausanne). 2022 May 30;9:882692. doi: 10.3389/fmed.2022.882692. eCollection 2022.

DOI:10.3389/fmed.2022.882692

PMID:35712095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9197116/

Abstract

BACKGROUND

Arguments still exist on prognosis of late-onset SLE, especially their kidney function. The purpose of this study was to investigate long-term kidney outcomes in patients with late-onset lupus nephritis (LN).

METHODS

A retrospective long-term cohort study was conducted in adult Chinese patients with LN. The patients were divided into late- (>50 years) and early-onset (<50 years) LN groups. The baseline characteristics, especially the kidney pathological characteristics, were compared. The cohort was followed-up for kidney outcome defined as doubling of serum creatinine or ESRD. Cox regression analysis was used to examine the association between late onset LN and its outcomes.

RESULTS

A total of 1,264 patients were recruited, who were assigned to late-onset LN with 102 patients and early-onset LN with 1,162 patients. The late-onset LN group showed a worse baseline kidney function and more chronic pathological lesions than the early-onset LN group. During a follow-up time of 55 (3, 207) months, 114 (13.1%) deaths occurred, 107 (12.2%) had doubling of creatinine, and 80 (9.1%) developed end-stage kidney disease. The 5- and 10-year survival rates of the late-onset LN group were 67.6 and 50.5%, respectively, which were much worse than those of the early-onset LN group (89.8 and 84.6%, respectively). However, no significant difference was found on kidney survival (log-rank chi-square = 3.55, = 0.06). Cox regression analysis showed that late-onset LN was an independent risk factor for patient survival (hazard ratio = 3.03, 95% CI (1.39, 6.58), = 0.005). Increased baseline serum creatinine was an independent risk factor for kidney survival of patients with late-onset LN.

CONCLUSIONS

Patients with late-onset LN had milder active lesions but severer chronic lesions in kidney pathology. They have poorer overall outcome but relatively favorable kidney outcome.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03001973, 22 December 2016 retrospectively registered.

摘要

背景

关于晚发性系统性红斑狼疮（SLE）的预后，尤其是其肾功能，仍存在争议。本研究旨在调查晚发性狼疮性肾炎（LN）患者的长期肾脏结局。

方法

对成年中国LN患者进行了一项回顾性长期队列研究。患者被分为晚发性（>50岁）和早发性（<50岁）LN组。比较了两组的基线特征，尤其是肾脏病理特征。对队列进行随访，以血清肌酐翻倍或终末期肾病（ESRD）定义肾脏结局。采用Cox回归分析来检验晚发性LN与其结局之间的关联。

结果

共招募了1264例患者，其中102例被分配到晚发性LN组，1162例被分配到早发性LN组。晚发性LN组的基线肾功能较早发性LN组更差，慢性病理病变更多。在55（3，207）个月的随访期内，发生了114例（13.1%）死亡，107例（12.2%）肌酐翻倍，80例（9.1%）发展为终末期肾病。晚发性LN组的5年和10年生存率分别为67.6%和50.5%，远低于早发性LN组（分别为89.8%和84.6%）。然而，在肾脏生存率方面未发现显著差异（对数秩卡方 = 3.55，P = 0.06）。Cox回归分析显示，晚发性LN是患者生存的独立危险因素（风险比 = 3.03，95%置信区间（1.39，6.58），P = 0.005）。基线血清肌酐升高是晚发性LN患者肾脏生存的独立危险因素。