Ginzler E M, Felson D T, Anthony J M, Anderson J J
Department of Medicine, SUNY-Health Science Center at Brooklyn 11203.
J Rheumatol. 1993 Oct;20(10):1694-700.
To assess the effect of hypertension on the development of renal functional deterioration, end stage renal disease and death in patients with systemic lupus erythematosus (SLE).
Person-years analysis using regression techniques to adjust for other baseline risk factors for adverse renal and patient survival outcomes.
Six hundred eighty-five patients with SLE were followed for a total of 4,137 person-years. The risk of renal deterioration (doubling of serum creatinine) and endstage renal disease (ESRD) both increased with increasing baseline mean arterial pressure (MAP) (both p > 0.05). Even after adjustment for age, sex, baseline serum creatinine, C3, erythrocyte sedimentation rate, hematocrit, anti-DNA antibodies, and proteinuria, those in the highest quartile of MAP had 2.3 times the odds of renal deterioration at 12 months and 4.6 times the odds of ESRD compared to those in the lowest quartile of MAP (both p < 0.01 comparing highest to lowest quartile of MAP). Also, hypertension increased the risk of mortality, especially between one and 2 years after blood pressure determination. The effect of hypertension was also independent of corticosteroid dose.
In patients with SLE, hypertension is a potent independent risk factor for adverse renal outcomes, and it also increases the risk of death.
评估高血压对系统性红斑狼疮（SLE）患者肾功能恶化、终末期肾病及死亡发生情况的影响。
采用人年分析并运用回归技术，对不良肾脏结局及患者生存结局的其他基线风险因素进行校正。
对685例SLE患者进行了总计4137人年的随访。随着基线平均动脉压（MAP）升高，肾脏恶化（血清肌酐翻倍）和终末期肾病（ESRD）的风险均增加（均p>0.05）。即使在校正年龄、性别、基线血清肌酐、C3、红细胞沉降率、血细胞比容、抗DNA抗体和蛋白尿后，MAP最高四分位数组患者在12个月时发生肾脏恶化的几率是MAP最低四分位数组的2.3倍，发生ESRD的几率是其4.6倍（MAP最高与最低四分位数组比较，均p<0.01）。此外，高血压增加了死亡风险，尤其是在血压测定后1至2年期间。高血压的影响也独立于皮质类固醇剂量。
在SLE患者中，高血压是不良肾脏结局的一个强有力的独立危险因素，并且还会增加死亡风险。
