狼疮肾炎的肾脏反应及其预测因素：56 例基于医院的患者的 2 年真实世界研究。
Renal response and its predictive factors of lupus nephritis: a 2-year real-world study of 56 hospital-based patients.
机构信息
Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Rd. Tianhe, Tianhe District, Guangzhou City, Guangdong Province, 510630, People's Republic of China.
Department of Nephrology, BaoAn Central Hospital of Shenzhen, Shenzhen, 518100, People's Republic of China.
出版信息
Clin Rheumatol. 2022 Nov;41(11):3363-3371. doi: 10.1007/s10067-022-06258-0. Epub 2022 Jul 19.
OBJECTIVES
Our aim was to evaluate the renal response rate of patients with lupus nephritis (LN) undergoing standard treatment during a 2-year follow-up and to investigate its predictive factors.
METHODS
A prospective cohort study that enrolled 56 clinically diagnosed LN patients with urinary protein positivity was carried out. All patients underwent standard treatment. All patients were followed up at 6-month intervals for 2 years. Data on renal response and clinical characteristics were collected and analyzed.
RESULTS
Among 56 patients, 27 (48.2%) and 13 (23.2%) patients achieved complete renal response (CR) and partial renal response (PR) at 6 months after induction therapy, respectively, and 42 (75.0%) and 4 (7.1%) patients developed CR and PR at 2 years. Among patients who achieved PR at 6 months, 90.0% achieved CR at 24 months, while only 37.5% of the patients who were unresponsive at 6 months achieved CR. In the multivariable Cox proportional-hazards model, female (OR 6.51, 95% CI 1.23-34.52, p = 0.028), disease duration (OR 0.84, 95% CI 0.73-0.98, p = 0.021), achieving PR within 6 months (OR 8.09, 95% CI 2.06-31.73, p = 0.003), and urine protein/creatinine ratio (UPCR) (OR 0.998, 95% CI 0.996-1.000, p = 0.025) were found to be predictive factors of CR.
CONCLUSION
A total of 48.2% of patients achieved CR at 6 months of induction therapy, and the response rates gradually increased to 60.7%, 64.3%, and 75.0% at 12, 18, and 24 months. Besides, female, disease duration, partial response within 6 months, and UPCR were predictive factors for a complete renal response. Key Points • We evaluate the renal response rates in Chinese patients with lupus nephritis in the real world for 2 years. • A total of 48.2% and 75.0% of patients achieved a complete response after standard treatment for 6 months and 2 years. • Female, disease duration, partial response within 6 months, and UPCR are predictors of complete renal response.
目的
本研究旨在评估接受标准治疗的狼疮肾炎（LN）患者在 2 年随访期间的肾脏反应率，并探讨其预测因素。
方法
本研究为前瞻性队列研究，纳入了 56 例临床诊断为 LN 且尿蛋白阳性的患者。所有患者均接受标准治疗。所有患者均在 2 年内每 6 个月随访一次。收集并分析患者的肾脏反应和临床特征数据。
结果
在 56 例患者中，诱导治疗后 6 个月时分别有 27 例（48.2%）和 13 例（23.2%）患者达到完全肾脏反应（CR）和部分肾脏反应（PR），而在 2 年时分别有 42 例（75.0%）和 4 例（7.1%）患者达到 CR 和 PR。在 6 个月时达到 PR 的患者中，90.0%在 24 个月时达到 CR，而在 6 个月时无反应的患者中仅 37.5%达到 CR。在多变量 Cox 比例风险模型中，女性（OR 6.51，95%CI 1.23-34.52，p=0.028）、疾病持续时间（OR 0.84，95%CI 0.73-0.98，p=0.021）、6 个月内达到 PR（OR 8.09，95%CI 2.06-31.73，p=0.003）和尿蛋白/肌酐比值（UPCR）（OR 0.998，95%CI 0.996-1.000，p=0.025）是 CR 的预测因素。
结论
诱导治疗 6 个月时，共有 48.2%的患者达到 CR，反应率逐渐增加至 12、18 和 24 个月时的 60.7%、64.3%和 75.0%。此外，女性、疾病持续时间、6 个月内部分反应和 UPCR 是完全肾脏反应的预测因素。
关键点
我们评估了中国狼疮肾炎患者在现实世界中接受标准治疗 2 年的肾脏反应率。
标准治疗 6 个月和 2 年后，分别有 48.2%和 75.0%的患者达到完全缓解。
女性、疾病持续时间、6 个月内部分缓解和 UPCR 是完全肾脏反应的预测因素。
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