Qijiao Wei, Fujia Huang, Bing Yang, Changyan Wang, Linqing Zhong, Yanqing Dong, Wei Wang, Hongmei Song
Department of Pediatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China.
Immun Inflamm Dis. 2025 Feb;13(2):e70146. doi: 10.1002/iid3.70146.
Childhood-onset lupus nephritis (LN) tends to be more severe than in adults. A significant correlation between remission at 3 months of induction therapy and remission after 3 years was found in adults. While few studies on the risk factors of poor early prognosis in children with LN were made. Thus, this study investigated the risk factors of early poor response to help doctors develop effective treatment strategies.
A total of 99 LN children at Peking Union Medical College Hospital from January 2012 to January 2018 were evaluated and clinical data were retrospectively collected. In the study, a complete remission (CR) was defined as laboratory test results were completely normal, including blood routine, renal function, albumin, complement, and erythrocyte sedimentation rate, and the 24-h urinary total protein (24 h UTP) was less than 150 mg. After 3 months of treatment, 15 children achieved CR, and they were in good prognosis group (n = 15). While 84 did not achieve CR, and they were in poor prognosis group (n = 84). We compared the differences of clinical and laboratory indicators between the two groups.
According to inclusion and exclusion criteria, 99 of 116 children with LN were included in this study. And 15 LN children were in good prognosis group. While 84 patients were in poor prognosis group. The incidence of rash (32.1% vs. 6.7%, p = 0.036) and oral ulcer (81.0% vs. 53.3%, p = 0.027) in poor prognosis group is higher than that in the good prognosis group. The 24 h UTP (g) [2.46 (1.41, 4.86) vs. 0.56 (0.30, 0.66), p < 0.001] and the serum creatinine (umol/L) [53.0 (40.3, 65.0) vs. 39.0 (29.8, 51.5), p = 0.017] were higher in poor prognosis group. The albumin (g/L) (28.7 ± 8.1 vs. 34.5 ± 5.3, p = 0.003) is lower in poor prognosis group. Logistic regression analysis showed that rash (p = 0.036), oral ulcer (p = 0.027), high 24 h UTP (p < 0.001), high creatinine (p = 0.017), and low serum albumin (p = 0.003) were significantly associated with poor early prognosis in childhood-onset LN.
The occurrence of rash cannot be ignored, especially for children with oral ulcers, a comprehensive evaluation of each system should be carried out, so as not to cause inactive treatment and affect the prognosis. High 24 h UTP have a positive predictive value for the early poor outcome of childhood-onset LN. Active control of proteinuria and achieving rapid renal remission is crucial for good prognosis.
儿童期起病的狼疮性肾炎（LN）往往比成人更严重。在成人中发现诱导治疗3个月时的缓解与3年后的缓解之间存在显著相关性。而关于儿童LN早期预后不良危险因素的研究较少。因此，本研究调查早期反应不佳的危险因素，以帮助医生制定有效的治疗策略。
对2012年1月至2018年1月在北京协和医院的99例LN患儿进行评估，并回顾性收集临床资料。本研究中，完全缓解（CR）定义为实验室检查结果完全正常，包括血常规、肾功能、白蛋白、补体和红细胞沉降率，且24小时尿总蛋白（24 h UTP）小于150 mg。治疗3个月后，15例患儿达到CR，他们属于预后良好组（n = 15）。而84例未达到CR，他们属于预后不良组（n = 84）。我们比较了两组之间临床和实验室指标的差异。
根据纳入和排除标准，116例LN患儿中的99例被纳入本研究。15例LN患儿属于预后良好组。而84例患者属于预后不良组。预后不良组的皮疹发生率（32.1% 对 6.7%，p = 0.036）和口腔溃疡发生率（81.0% 对 53.3%，p = 0.027）高于预后良好组。预后不良组的24 h UTP（g）[2.46（1.41，4.86）对 0.56（0.30，0.66），p < 0.001] 和血清肌酐（umol/L）[53.0（40.3，65.0）对 39.0（29.8，51.5），p = 0.017] 更高。预后不良组的白蛋白（g/L）（28.7 ± 8.1对34.5 ± 5.3，p = 0.003）更低。逻辑回归分析表明，皮疹（p = 0.036）、口腔溃疡（p = 0.027）、高24 h UTP（p < 0.001）、高肌酐（p = 0.017）和低血清白蛋白（p = 0.003）与儿童期起病LN的早期预后不良显著相关。
皮疹的发生不容忽视，尤其是对于有口腔溃疡的儿童，应进行各系统的综合评估，以免导致治疗不积极而影响预后。高24 h UTP对儿童期起病LN的早期不良结局有阳性预测价值。积极控制蛋白尿并实现快速肾脏缓解对良好预后至关重要。
