Ciruelo E, de la Cruz J, López I, Gómez-Reino J J
Servicio de Reumatología, Hospital Universitario Doce de Octubre, Carretera de Andalucia, Madrid, Spain.
Arthritis Rheum. 1996 Dec;39(12):2028-34. doi: 10.1002/art.1780391212.
To determine the cumulative rate of relapse of lupus nephritis that has been treated successfully with cyclophosphamide (CYC), and to estimate the association between time to relapse and demographic, clinical, laboratory, and treatment variables.
This was an observational study of 48 systemic lupus erythematosus (SLE) patients who were treated successfully with CYC between 1979 and 1993 and followed up thereafter at 3 university hospitals. Demographic and clinical variables, laboratory data during the first month of nephritis, and therapy-related variables were recorded from charts. Renal biopsy specimens were retrieved and analyzed by a pathologist. Relapse of nephritis was the outcome of interest. Descriptive analysis of patients who did and those who did not have a relapse was performed by chi-square test, Fisher's exact test, and Wilcoxon 2-sample test. The cumulative rate of relapse was computed using the actuarial method. Univariate comparisons of time to relapse were computed by log-rank test. Proportional hazards modeling was used to assess the combined effect of patient characteristics that have been hypothesized to be prognostic factors.
Nephritis relapsed in 11 patients. Previous hematologic disorder, arthritis or arthralgia, and the use of CYC in oral form were more frequent in patients who had a relapse. The cumulative rate of relapse was 25% and 46% at 5 years and 10 years, respectively. A significant univariate difference in time to relapse was found when patients were stratified by time from diagnosis to initiation of CYC treatment (< or = 5 months versus > 5 months; P = 0.02). By multivariate analysis, age < 29 years at nephritis onset (relative risk [RR] 6.29, 95% confidence interval [95% CI] 1.13-34.94, P = 0.03) and delay of > 5 months from onset of nephritis to initiation of CYC therapy (RR 3.66, 95% CI 1.06-12.63, P = 0.04) were independently associated with time to relapse.
A selected population of SLE patients may have long-term remission of renal disease following successful CYC therapy. Patients in whom CYC treatment is delayed or who are young at the time of nephritis onset are at increased risk of relapse.
确定经环磷酰胺（CYC）成功治疗的狼疮性肾炎的累积复发率，并评估复发时间与人口统计学、临床、实验室及治疗变量之间的关联。
这是一项对48例系统性红斑狼疮（SLE）患者的观察性研究，这些患者在1979年至1993年间接受CYC成功治疗，此后在3所大学医院进行随访。从病历中记录人口统计学和临床变量、肾炎第一个月的实验室数据以及治疗相关变量。检索肾活检标本并由病理学家进行分析。肾炎复发是感兴趣的结局。对复发和未复发患者进行描述性分析，采用卡方检验、Fisher精确检验和Wilcoxon两样本检验。使用精算方法计算累积复发率。通过对数秩检验计算复发时间的单因素比较。采用比例风险模型评估假设为预后因素的患者特征的综合效应。
11例患者出现肾炎复发。复发患者既往血液系统疾病、关节炎或关节痛以及口服CYC的情况更为常见。5年和10年的累积复发率分别为25%和46%。当根据从诊断到开始CYC治疗的时间对患者进行分层时（≤5个月与>5个月；P = 0.02），发现复发时间存在显著的单因素差异。多因素分析显示，肾炎发病时年龄<29岁（相对风险[RR] 6.29，95%置信区间[95% CI] 1.13 - 34.94，P = 0.03）以及从肾炎发病到开始CYC治疗延迟>5个月（RR 3.66，95% CI 1.06 - 12.63，P = 0.04）与复发时间独立相关。
部分SLE患者在CYC治疗成功后可能有肾病的长期缓解。CYC治疗延迟或肾炎发病时年轻的患者复发风险增加。
