Chu S J, Chang D M, Kuo S Y, Chang M L, Lee H S, Chen A, Shieh S D
Division of Rheumatology-Immunology-Allergy, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jan;53(1):27-36.
The influence of renal morphology and clinical factors at biopsy on the development of renal failure in patients with lupus nephritis remain controversial. We investigated the relation between renal histologic finding and clinical manifestations, and evaluated prognostic factors and short-term prognosis among patients with lupus nephritis.
Seventy patients with lupus nephritis were enrolled in the study from 1982 to 1992 at the Tri-Service General Hospital. Renal biopsy specimens from these patients were assessed according to the World Health Organization (WHO) classification, activity and chronicity indices, and clinical parameters. Survival was analyzed by using the day of renal biopsy as the starting point. The end point of renal survival was the date when patient started to receive regular hemodialysis.
In pathological finding, one patient was grouped as Class I (1.4%); 14, as Class II (20%); 15, as Class III (21.4%); 29, as Class IV (41.4%); 9, as Class V (12.9%), and 2, as Class VI (2.9%). The scores of activity indices were highest in Class IV. The blood levels of C3 and C4 in Class V were significantly higher than Class IV. The values of BUN and 24-hour urine protein in Class II were significant lower than Class IV. Patients who progressed to renal failure had significantly higher numbers of death, higher serum creatinine and chronicity index, less creatinine clearance, and higher numbers of hypertension at the time of biopsy. Nephrotic syndrome was not associated with renal failure. Patient and renal survivals did not differ among WHO classifications. The patient and renal survivals were 84%, 60% and 85%, 72% at one and five years, respectively. Seventeen patients (24.2%) progressed to end-stage renal disease and 21 patients (30%) died during the study period. The leading causes of death were sepsis and renal failure.
WHO classification had little correlation with clinical and renal information. At the time of biopsy the elevated serum creatinine and hypertension were good predictors for end-stage renal disease. Poor patient and renal survivals were found in this study.
狼疮性肾炎患者活检时肾脏形态及临床因素对肾衰竭发展的影响仍存在争议。我们研究了肾脏组织学发现与临床表现之间的关系，并评估了狼疮性肾炎患者的预后因素和短期预后。
1982年至1992年，三军总医院招募了70例狼疮性肾炎患者。根据世界卫生组织（WHO）分类、活动度和慢性化指数以及临床参数对这些患者的肾活检标本进行评估。以肾活检日为起点分析生存率。肾脏生存终点为患者开始接受规律血液透析的日期。
在病理检查结果中，1例患者归为I类（1.4%）；14例归为II类（20%）；15例归为III类（21.4%）；29例归为IV类（41.4%）；9例归为V类（12.9%），2例归为VI类（2.9%）。活动度指数得分在IV类中最高。V类患者的C3和C4血水平显著高于IV类。II类患者的尿素氮和24小时尿蛋白值显著低于IV类。进展为肾衰竭的患者在活检时死亡人数显著更多，血清肌酐和慢性化指数更高，肌酐清除率更低，高血压人数更多。肾病综合征与肾衰竭无关。WHO分类之间患者和肾脏生存率无差异。患者和肾脏生存率在1年和5年时分别为84%、60%和85%、72%。17例患者（24.2%）进展为终末期肾病，21例患者（30%）在研究期间死亡。主要死亡原因是败血症和肾衰竭。
WHO分类与临床及肾脏信息相关性不大。活检时血清肌酐升高和高血压是终末期肾病的良好预测指标。本研究中患者和肾脏生存率较差。
