Donadio J V, Hart G M, Bergstralh E J, Holley K E
Department of Biostatistics, Mayo Clinic, Rochester, MN 55905, USA.
Lupus. 1995 Apr;4(2):109-15. doi: 10.1177/096120339500400206.
Over the past 50 years, survival has improved in patients with systemic lupus erythematosus and associated nephritis. Yet, there are few long-term outcome studies in patients with well-defined nephropathy. We examined the outcome of 439 patients with lupus nephritis who were seen at the Mayo Clinic between 1964 and 1986 in whom renal biopsies were assessed using the World Health Organization (WHO) classification. There were 341 women and 98 men (mean +/- s.d., age 33.5 +/- 14 years); 200 (46%) patients were hypertensive and 249 (57%) had impaired renal function at renal biopsy. All WHO morphologic classes were represented and 339 (77%) patients had class III, IV and V (the more severe forms of nephritis). Follow-up averaged 10.2 years per patient. At last contact, 286 (65%) patients were alive and 153 (35%) were dead. Overall patient survival was 80%, 69% and 53% at 5, 10 and 20 years after biopsy that was significantly worse than expected survival (P < 0.001). Ten-year cumulative patient survival improved comparing earlier to more recent time spans: 64% in 231 patients seen during 1964-75; 76% in 2089 patients studied during 1976-86 (P = 0.03). Survival free of renal failure was 83%, 74% and 64% at 5, 10 and 20 years, and survival was unfavorably influenced by progressive WHO class, hypertension, impaired renal function, nephrotic range proteinuria, hypoalbuminemia and anemia. Multivariate analysis found impaired renal function, increased urine protein, anemia and younger age to be independent predictors of renal failure. WHO class was not a significant predictor when adjusted for these four factors. Cardiovascular events accounted for 48% of the known deaths and were equally distributed across all WHO classes, followed by infections, renal failure, malignancy, respiratory failure and gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
在过去50年中，系统性红斑狼疮及相关肾炎患者的生存率有所提高。然而，针对明确肾病患者的长期预后研究却很少。我们研究了1964年至1986年间在梅奥诊所就诊的439例狼疮性肾炎患者的预后情况，这些患者的肾活检采用世界卫生组织（WHO）分类法进行评估。其中有341名女性和98名男性（平均±标准差，年龄33.5±14岁）；200名（46%）患者患有高血压，249名（57%）患者在肾活检时肾功能受损。所有WHO形态学类别均有代表，339名（77%）患者为III、IV和V级（更严重的肾炎形式）。每位患者的随访平均为10.2年。在最后一次联系时，286名（65%）患者存活，153名（35%）患者死亡。活检后5年、10年和20年的总体患者生存率分别为80%、69%和53%，显著低于预期生存率（P<0.001）。与早期时间段相比，近期时间段的10年累积患者生存率有所提高：1964 - 1975年间就诊的231名患者中为64%；1976 - 1986年间研究的208名患者中为76%（P = 0.03）。无肾衰竭生存率在5年、10年和20年分别为83%、74%和64%，生存率受到WHO分级进展、高血压、肾功能受损、肾病范围蛋白尿、低蛋白血症和贫血的不利影响。多变量分析发现肾功能受损、尿蛋白增加、贫血和年龄较小是肾衰竭的独立预测因素。调整这四个因素后，WHO分级不是一个显著的预测因素。心血管事件占已知死亡病例的48%，在所有WHO分级中分布均匀，其次是感染、肾衰竭、恶性肿瘤、呼吸衰竭和胃肠道出血。（摘要截选于250字）
