摘要
目的分析狼疮性肾炎(lupus nephritis,LN)患者不同病理分型与临床疾病活动性和预后的关系,以及终末期肾病(end-stage renal disease,ESRD)的危险因素。方法回顾性分析本院2013-2018年经肾活检确诊的305例LN患者,按肾脏病理分为毛细血管内细胞增多性LN(包括LN-Ⅲ/Ⅳ146例、合并膜性病变的LN-Ⅲ/Ⅳ+Ⅴ106例)和非毛细血管内细胞增多性LN(LN-Ⅱ/Ⅴ53例),比较不同病理分型患者的疾病活动性和预后的差异,通过回归分析探索ESRD的危险因素。结果与LN-Ⅱ/Ⅴ相比,LN-Ⅲ/Ⅳ(伴或不伴LN-Ⅴ)患者SLEDAI评分≥10分比例更高(66.3%vs 45.3%),且出现浆膜炎、脱发、贫血、血肌酐增高、血尿、ESRD以及抗ds-DNA、AnuA抗体阳性的比例均更高(P<0.05)。ESRD整体累积发病率为14.4%,LN-Ⅲ/Ⅳ(伴或不伴LN-Ⅴ)是ESRD的独立危险因素(OR值为2.977),此外,抗dsDNA抗体阳性、血肌酐增高、SLEDAI评分≥10分亦为ESRD的独立危险因素(OR值分别为1.722、5.484、2.070)。不同病理类型患者的生存时间分布差异无统计学意义(P>0.05)。结论LN-Ⅲ/Ⅳ(伴或不伴LN-Ⅴ)型患者表现出更高的疾病活动性,肾脏和肾外损害更重,进展为ESRD的风险更高。
Objective To explore the relationship of lupus nephritis(LN)with different pathological types with disease activity and prognosis,and investigate the risk factors of end-stage renal disease(ESRD).Methods A total of 305 pathologically-confirmed LN patients admitted in our hospital from the year of 2013 to 2018 were retrospectively enrolled in this study.According to the results of renal biopsy,they were divided into mesangial hypercellularity LN(including 146 cases of LN-Ⅲ/Ⅳand 106 cases of LN-Ⅲ/Ⅳ+Ⅴ)and non-mesangial hypercellularity LN(53 cases of LN-Ⅱ/Ⅴ).The disease activity and prognosis of the patients with different pathological types were compared,and the risk factors of ESRD were explored.Results There were more patients with Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)≥10(66.3%vs 45.3%),occurrences of serositis,hair loss,anemia,higher serum creatinine,hematuria,and ESRD,and manifestations of anti-dsDNA antibody and anti-AnuA antibody in the LN-Ⅲ/Ⅳpatients(with or without LN-Ⅴ)than the LN-Ⅱ/Ⅴpatients(P<0.05).The cumulative incidence of ESRD was 14.4%,and LN-Ⅲ/Ⅳ(with or without LN-Ⅴ),as well as anti-dsDNA antibody,higher serum creatinine,and SLEDAI≥10,was identified as independent risk factors for ESRD(OR=2.977,1.722,5.484,2.070).But there was no statistical difference in survival time among different pathological types(P>0.05).Conclusion The LN-Ⅲ/Ⅳpatients(with or without LN-Ⅴ)have higher disease activity,severer impairment both in inside and outside of the kidney,and higher risk of progression to ESRD.
作者
吴奇俊
张东梅
翟志芳
宋志强
WU Qijun;ZHANG Dongmei;ZHAI Zhifang;SONG Zhiqiang(Department of Dermatology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2020年第23期2336-2340,共5页
Journal of Third Military Medical University
基金
国家自然科学基金面上项目(81673068,81773316)。
关键词
狼疮性肾炎
临床表现
病理分型
终末期肾脏病
危险因素
lupus nephritis
clinical features
pathological types
end-stage renal disease
risk factor
