弥漫增生型狼疮肾炎的远期预后及影响因素分析

目的调查研究弥漫增生性狼疮肾炎(DPLN)的远期预后及影响因素。方法回顾性观察2000年1月至2014年12月在温州医科大学附属第一医院住院的所有DPLN患者的长期随访终点并分析预后影响因素。将病例按入院时估算肾小球滤过率(eGFR)分为3组:eGFR≥60 ml·min^-1·1.73 m^-2为普通组;15 ml·min^-1·1.73 m^-2≤eGFR<60 ml·min^-1·1.73 m^-2为重症组;eGFR<15 ml·min^-1·1.73 m^-2或需透析患者为危重组。分析3组患者临床,病理和预后的差异。统计学方法采用单因素方差分析、χ^2检验和Kaplan-Meier生存曲线和Cox回归分析。结果167例患者符合纳入标准,女性155例,平均年龄(30±10)岁,平均随访(61±45)个月。所有患者5年和10年累计人肾存活率分别为86%和79%。Kaplan-Meier生存分析显示普通组、重症组和危重组10年累计人肾存活率分别为91%,70%和8%,3组间差异有统计学意义(χ^2=121.93,P<0.01);普通组和重症组(χ^2=4.05,P<0.05)、普通组和危重组(χ^2=97.05,P<0.01)、重症组和危重组(χ^2=52.28,P<0.01)相比,差异均具有统计学意义。多因素Cox回归分析显示:血红蛋白<80 g/L[HR=2.7,95%CI(1.2,6.3),P=0.019],eGFR<60 ml·min^-1·1.73 m^-2[HR=4.1,95%CI(2.0,8.2),P<0.01]和大新月体比率≥30%[HR=1.8,95%CI(1.1,2.9),P=0.021]是ESRD的主要影响因素。结论DPLN伴基线肾功能正常或轻度下降的患者长期预后较好,基线中重度肾功能损害,贫血和大新月体比率高是预后不良的预测因素。

Long-term outcome and prognostic indicators of diffuse proliferative lupus nephritis

Objective To investigate the long-term outcome and prognostic indicators of diffuse pro-liferative lupus nephritis(DPLN).Methods The primary endpoint of long-term follow-up and factors pos-sibly influencing the outcome were analyzed retrospectively in DPLN patients admitted to the First Affiliated Hospital of Wenzhou Medical University between Jan 1,2000 and Dec 31,2014.Patients were classified into three groups according to the evaluated glomerular filtration rate(eGFR)on the first day of admission:eGFR≥60 ml·min^-1·1.73 m^-2(regular illness group);15 ml·min^-1·1.73 m^-2≤eGFR<60 ml·min^-1·1.73 m^-2(serious illness group);eGFR<15 ml·min^-1·1.73 m^-2 or dialysis(critical illness group).Clinical,histological,and outcome differences among the three groups were evaluated and compared using one-way analysis of variance(ANOVA),χ^2 test,Kaplan-Meier survival curve and Cox reggression analysis.Results 167 DPLN patients were studied[155 women;mean age(30±10)years;mean follow-up of(61±45)months].Renal and patient survival of all patients was 86%at 5 years and 79%at 10 years.Kaplan-Meier analysis showed the renal and patient survival rate at 10 years in the regular illness group,serious illness group and critical illness group was 91%,70%and 8%,respectively(χ^2=121.93,P<0.01,overall);regular illness group vs serious illness group(χ^2=4.05,P<0.05);regular illness group vs critical illness group(χ^2=97.05,P<0.01);serious illness group vs critical illness group(χ^2=52.28,P<0.01).Multivariable Cox regression analysis found that haematoglobin(Hb)<80 g/L[HR=2.7,95%CI(1.2,6.3),P=0.019],eGFR<60 ml·min^-1·1.73 m^-2[HR=4.1,95%CI(2.0,8.2),P<0.01]and large crescents≥30%[HR=1.8,95%CI(1.1,2.9),P=0.021],were risk factors for the long-term outcome.Conclusion DPLN patients with normal or slightly decreased renal function have a better long-term prognosis.Moderate to severe impairment of renal function,anemia and large crescents are associated with poor outcome.