Dooley M A, Hogan S, Jennette C, Falk R
Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, USA.
Kidney Int. 1997 Apr;51(4):1188-95. doi: 10.1038/ki.1997.162.
Intravenous cyclophosphamide is widely used to treat severe lupus nephritis. Yet interpretation of the literature is limited by the small number of patients evaluated with varied renal histology. We analyzed the renal outcome of cyclophosphamide therapy for diffuse proliferative lupus glomerulonephritis in a cohort of 89 patients from the Glomerular Disease Collaborative Network. Statistical analysis included Wilcoxon rank sum tests or continuity-adjusted chi-square for comparisons between groups. Kaplan-Meier survival function estimates were calculated for renal survival curves. Cox's proportional hazards models were employed for multivariate evaluation. The renal survival rate declined yearly from 89%, to 86%, 81%, 75%, and 71% at year 5. Renal survival was significantly worse in blacks compared with white patients. Among white patients 95% retained renal function at year 5 whereas black patients showed a progressive yearly decline from 85% at year 1, to 79%, 72%, 62%, and 58% at year 5. Racial differences in renal outcome were independent of age, duration of lupus, history of hypertension, hypertension control during therapy, and activity or chronicity indices on renal biopsy. The factors that predispose black patients to more aggressive and treatment-resistant lupus nephritis are not apparent.
静脉注射环磷酰胺被广泛用于治疗重症狼疮性肾炎。然而，由于接受评估的患者数量较少且肾组织学类型各异，文献解读受到限制。我们分析了肾小球疾病协作网络中89例弥漫性增殖性狼疮性肾炎患者接受环磷酰胺治疗后的肾脏转归情况。统计分析包括采用Wilcoxon秩和检验或连续性校正卡方检验进行组间比较。计算Kaplan-Meier生存函数估计值以绘制肾脏生存曲线。采用Cox比例风险模型进行多变量评估。肾脏生存率在第5年时从89%逐年下降至86%、81%、75%和71%。黑人患者的肾脏生存率显著低于白人患者。在白人患者中，95%在第5年时仍保留肾功能，而黑人患者则从第1年的85%逐年下降，至第5年时降至79%、72%、62%和58%。肾脏转归的种族差异与年龄、狼疮病程、高血压病史、治疗期间的高血压控制情况以及肾活检时的活动或慢性指数无关。导致黑人患者狼疮性肾炎更具侵袭性且对治疗抵抗的因素尚不明确。
