狼疮肾炎腹膜透析患者的长期预后研究

目的 探讨狼疮肾炎(LN)腹膜透析(腹透)患者的长期预后.方法 入选1995年5月1日至2013年4月30日期间在本院开始腹透且资料完整的LN患者(n=33),同时入选与其年龄、性别、并发症匹配的非LN腹透患者(n=33)作为对照组.所有入选患者均随访至死亡、退出腹透、转其他中心或至研究终止.采用Kaplan-Meier生存分析和Log-Rank检验比较两组患者的生存率、技术生存率和无腹膜炎生存率.结果 腹透开始时,LN组患者的估算肾小球滤过率(eGFR)、抗双链DNA (anti-dsDNA)和高敏C反应蛋白(hs-CRP)水平均明显高于对照组(均P＜ 0.05).截至研究终止,LN组患者有13例(39.4％)死亡,8例(24.2％)转血液透析(血透),5例(15.2％)肾移植,2例(6.1％)转其他中心.LN组患者最常见的死亡原因是感染(9例,69.2％),其中又以腹膜炎最常见(6例,46.2％),而对照组患者最常见的死亡原因是心血管疾病(5例,83.3％).Kaplan-Meier分析显示LN组患者的1、3、5年患者生存率为82％、49％、49％,明显低于对照组(x2=8.455,P=0.004).LN组患者的技术生存率也明显低于对照组(x2=6.753,P=0.009).LN组腹膜炎发生率为1次/20.5病人月,而对照组腹膜炎发生率为1次/67.6病人月.LN组患者的无腹膜炎生存率显著低于对照组(x2=8.256,P=0.004).结论 LN腹膜透析患者的长期预后较差.腹膜炎是LN腹透患者死亡和技术失败的主要原因.

Long-term outcome of lupus nephritis patients treated with peritoneal dialysis

Objective To investigate the long-term outcome of Chinese lupus nephritis (LN) patients undergoing peritoneal dialysis (PD). Methods All LN patients with end-stage renal disease (ESRD) initiating PD between May 1, 1995 and Apr 30, 2013 at Renji Hospital, Shanghai Jiao Tong University School of Medicine, China, with complete data (n=33) were enrolled. Another 33 age-, gender- and comorbidity-matched non-LN patients receiving PD were selected as the control group for the study. All patients were followed up from the date of PD initiation until death, cessation of PD, transfer to other centers or the end of this study (Dec 31, 2013). Kaplan-Meier analysis and Log-Rank test were applied to compare patient survival, technique survival and peritonitis-free survival between two groups. Results Compared to the control group, LN patients had higher eGFR, anti-dsDNA and hs-CRP level at the starting of PD. By the end of the study, in the LN group 13 (39.4%) patients died, 8(24.2%) patients switched to hemodialysis (HD), 5(15.2%) patients transplanted and 2(6.1%) patients transferred to other centers. Infection was the most common cause of death in the LN group (9 patients, 69.2%), and majority of death was caused by PD-related peritonitis (6 patients, 46.2%), while cardiovascular disease (CVD) was the leading cause of death in the control group (5 patients, 83.3%). Kaplan-Meier analysis showed that LN patients had significantly lower patient survival (χ2=8.455, P=0.004). For both LN group (6 patients, 75.0%) and control group (4 patients, 66.7%), peritonitis was the leading cause of transfer to HD. Compared to the control group, LN patients had significantly lower technique survival (χ2=6.753, P=0.009). Peritonitis rates were 1 episode/20.5 patient-months in the LN group and 1 episode/67.6 patient-months in the control group respectively. LN patients had significantly shorter peritonitis-free survival (χ2=8.256, P=0.004) when compared to their counterparts in the control group. Conclusion LN patients with ESRD receiving PD have inferior clinical outcome. Peritonitis is the most common cause of death and technique failure in LN patients.