Austin H A, Muenz L R, Joyce K M, Antonovych T A, Kullick M E, Klippel J H, Decker J L, Balow J E
Am J Med. 1983 Sep;75(3):382-91. doi: 10.1016/0002-9343(83)90338-8.
The predictive value of laboratory results and renal histologic data was examined in 102 patients upon entry into prospective, randomized, therapeutic trials of lupus nephritis. Three clinical features at the time of entry into the study were individually associated with increased rates of renal failure: age less than 24 years, male gender, and an elevated serum creatinine level. Subjects with diffuse proliferative or membranoproliferative glomerulonephritis were at a modest but significantly increased risk for the development of end-stage renal disease compared with patients with other classes of lupus nephritis. Semiquantitative scores of histologic features (specified by activity and chronicity indexes) identified subgroups of patients with comparatively high renal failure rates. To address the controversial issue of whether renal histologic data significantly improve the outcome predictions in patients with lupus nephritis, multivariate survival models were generated, permitting simultaneous consideration of multiple prognostic factors. Outcome predictions based on the strongest clinical predictors (age, sex, and serum creatinine level) were significantly enhanced by the addition of activity and chronicity indexes. Only age and chronicity index contributed significantly to the five-variable model and together constituted a two-variable model, the predictions of which were similar to observed outcomes. In the context of the highly significant prognostic indicators (age and chronicity index), immunosuppressive agents appeared to provide a slight therapeutic advantage over oral corticosteroids alone.
在102例狼疮性肾炎患者进入前瞻性、随机、治疗性试验时，对实验室检查结果和肾脏组织学数据的预测价值进行了研究。进入研究时的三个临床特征分别与肾衰竭发生率增加相关：年龄小于24岁、男性以及血清肌酐水平升高。与其他类型狼疮性肾炎患者相比，弥漫性增殖性或膜增殖性肾小球肾炎患者发生终末期肾病的风险虽适度但显著增加。组织学特征的半定量评分（由活动度和慢性化指数确定）识别出了肾衰竭发生率相对较高的患者亚组。为解决肾脏组织学数据是否能显著改善狼疮性肾炎患者预后预测这一有争议的问题，构建了多变量生存模型，从而能够同时考虑多个预后因素。通过加入活动度和慢性化指数，基于最强临床预测指标（年龄、性别和血清肌酐水平）的预后预测得到了显著增强。只有年龄和慢性化指数对五变量模型有显著贡献，二者共同构成了一个二变量模型，其预测结果与观察到的结果相似。在具有高度显著预后指标（年龄和慢性化指数）的背景下，免疫抑制剂似乎比单独使用口服糖皮质激素具有轻微的治疗优势。
