Zhang L, Chen C, Weng M T, Zheng A P, Su M L, Wang Q W, Cai Y M
Department of Rheumatology & Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Department of Medical Pathology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Dec 18;54(6):1094-1098. doi: 10.19723/j.issn.1671-167X.2022.06.006.
To observe the tubulointerstitial damage (TID) in lupus nephritis (LN) and investigate the relationship between autoantibodies and TID in lupus nephritis.
This cross-sectional study was conducted in a comprehensive tertiary hospital in Peking University Shenzhen Hospital. From March 2012 to July 2021, LN patients who performed renal biopsy were enrolled in the study. Clinical, laboratory and pathology data were collected. We classified the patients into none-or-mild group and moderate-to-severe groups according to the severity of interstitial fibrosis (IF) /tubular atrophy (TA) or tubulointerstitial inflammation (TII). The test, test and Chi-square test were used for statistical analysis as appropriate.
A total of 226 patients were included, of who 190 (84%) were female with a median age of 32 (26, 39) years. 89% (201/226) of the patients who pathologically proved to be proliferative LN by renal biopsy. The frequency of moderate-to-severe TII and moderate-to-severe IF/TA was 30% (67/226) and 34% (76/226) respectively. For autoantibodies, the patients with moderate-to-severe TII had a lower rate of positive serum anti-ribonucleoprotein (anti-RNP) antibodies than the patients with none-or-mild TII (34% . 51%), and moderate-to-severe IF/TA had a lower rate of positive anti-ribosomal P protein (anti-P) antibodies than patients with none-or-mild IF/TA (19% . 33%). For other clinical indicators, the patients with moderate-to-severe TII and moderate-to-severe IF/TA were more often combined with proliferative LN, hypertension and anemia than the patients with none-or-mild TII and none-or-mild IF/TA, respectively. The patients with moderate-to-severe TII had higher serum creatinine values and lower glomerular filtration rates than the patients with none-or-mild TII. The patients with moderate-to-severe IF/TA had higher serum creatinine values, and lower glomerular filtration rates than the patients with none-or-mild IF/TA.
In patients with LN in Southern China, anti-RNP antibodies and anti-P antibodies may be potential protective factors for TII and IF/TA, respectively. More studies are needed to identify the risk factors of lupus patients with TID and investigate the correlation between autoantibodies and TID, which are critical for developing better preventive and therapeutic strategies to improve the survival rate of LN.
观察狼疮性肾炎（LN）患者的肾小管间质损伤（TID）情况，并探讨自身抗体与LN患者TID之间的关系。
本横断面研究在北京大学深圳医院这所综合性三级医院开展。2012年3月至2021年7月，纳入行肾活检的LN患者。收集临床、实验室及病理资料。根据间质纤维化（IF）/肾小管萎缩（TA）或肾小管间质炎症（TII）的严重程度，将患者分为无/轻度组和中/重度组。酌情采用检验、检验和卡方检验进行统计分析。
共纳入226例患者，其中190例（84%）为女性，中位年龄32（26，39）岁。89%（201/226）的患者经肾活检病理证实为增殖性LN。中/重度TII和中/重度IF/TA的发生率分别为30%（67/226）和34%（76/226）。对于自身抗体，中/重度TII患者血清抗核糖核蛋白（anti-RNP）抗体阳性率低于无/轻度TII患者（34%对51%），中/重度IF/TA患者抗核糖体P蛋白（anti-P）抗体阳性率低于无/轻度IF/TA患者（19%对33%）。对于其他临床指标，中/重度TII患者和中/重度IF/TA患者分别比无/轻度TII患者和无/轻度IF/TA患者更常合并增殖性LN、高血压和贫血。中/重度TII患者的血清肌酐值高于无/轻度TII患者，肾小球滤过率低于无/轻度TII患者。中/重度IF/TA患者的血清肌酐值更高，肾小球滤过率低于无/轻度IF/TA患者。
在华南地区的LN患者中，抗RNP抗体和抗P抗体可能分别是TII和IF/TA的潜在保护因素。需要更多研究来确定狼疮患者发生TID的危险因素，并研究自身抗体与TID之间的相关性，这对于制定更好的预防和治疗策略以提高LN患者的生存率至关重要。
