狼疮性肾炎患者生存率及其影响因素

Survival probability and predictors of death in patients with lupus nephritis

目的研究狼疮性肾炎(LN)病人的长期生存率,并分析影响生存率的预后因素。方法对1994年12月～2004年12月住院的326例LN病人进行回顾性分析,用寿命表分析生存率,采用Cox模型分析预后因素。结果LN病人1,5,10a生存率分别为88.3%,74.5%及60.2%。影响生存率的预后因素有高血压、浆膜炎,血清肌酐≥120umol/L,系统性红斑狼疮病活动指数(SLEDAI)≥20分,尿细胞管型,C3<0.8g/L及合并感染,其中血清肌酐升高,C3下降,SLEDAI≥20分是独立的预后影响因素,激素加环磷酰胺治疗能提高生存率。结论肾脏受损,C3下降及狼疮活动程度是影响LN预后的重要因素,积极的免疫抑制剂治疗有利于改善预后。

Objective To investigate the survival probability and predictors of death in patients with lupus nephritis （LN）. Methods 326 patients who were admitted into and diagnosed as LN at our hospital from Dec.1994 to Dec. 2004 were studied retrospectively. Survival proabilities were studied with life list and predictors of death were analyzed with the Coxmodel. Results The overall survival probabilities at 1,5 and 10 years after diagnosis were 88.3%, 74.5% and 60.2% respectively. Hypertension, serositis,serum creatinine ≥120umol/L, SLE disease activity index （SLEDAI） ≥20 scores, complement C3〈0.8g/L and infection were prediction factors for mortality,among which increased serum creatinine and decreased complement C3 and SLEDAI ≥ 20 scores were independent factors significantly associated with low survival probability. Prednisone plus cyclophosphamide could improve survival. Conclusion Renal abnormalities and high lupus activity index and decreased complement C3 are the most important survival predictors in LN patients. Active immunosuppressive therapy can improve the prognosis of LN.