摘要
目的:回顾性分析Ⅴ型狼疮性肾炎(LN)的远期预后及影响预后的因素。方法:临床符合系统性红斑狼疮,经肾活检诊断为Ⅴ型LN(ISN/RPS2003肾脏病理分型标准)的患者100例[女性90例,男性10例,平均年龄(32±9)岁]。通过Kaplan-Meier法估算人肾存活率,并建立COX风险模型,分析影响预后的危险因素。结果:100例平均随访(77.6±56)个月(中位时间59.5个月)。共2例死亡,5年、10年人存活率均为98%,5年、10年肾存活率分别为96.1%、92.7%。肾小管间质严重损害(RR66.514)、治疗初大量蛋白尿(RR19.159)和持续不缓解(RR9.834)是影响肾存活率的独立危险因素。进入终末期肾衰6例中3例治疗初即有严重肾小管间质病变,2例随访中发生转型(1例转为Ⅴ型伴Ⅳ型,1例转为Ⅴ型伴Ⅲ型),1例CSA中毒。并发症:包括感染(13%),血栓(3%),股骨头坏死(3%),糖尿病(4%)和肿瘤(1%)。结论:Ⅴ型LN10年人肾存活率达98%和93%,严重肾小管间质病变、大量蛋白尿和持续不缓解是Ⅴ型LN进展为ESRF的危险因素。
Objective:To analyze the long-term outcome of patients with membranous lupus nephropathy (MLN) and prognostic factors. Methodology:One hundred Chinese patients (female 90 and male 10 with a mean age 32 ± 9 years) suffered from systemic lupus erythematosus (SLE) and biopsy-proven MLN (ISN/RPS2003 classification criteria) were enrolled in this retrospective study. The patient survival and renal survival was estimated by Kaplan-Meier method, and Cox proportional hazards regression analysis was used to assess the risk factors associated with end stage renal failure (ESRF). Results:All patients were followed (77.6 ± 56) months. Eventually, two patients died, ten years patient survival was 98%, 5 and 10 years renal survival were 96. 1% and 92.7% respectively. It was found that severe tubular-interstitial lesion (RR 66. 514) , nephrotic range proteinuria (RR 19. 159) and continuous without remission (RR 9. 834) were independent risk factors to ESRF. Three of 6 patients who reached ESRF showed severe tubular-interstitial lesion on initial biopsy. Twenty-one patients underwent rebiopsy after (44 ±42) months'follow-up, eight (38.1%) of them ( MLN with class IV in 5, MLN with class Ⅲ in 2 and class VI in 1 ) had transformed their histological classifications on repeat renal biopsy, and three (37. 5% ) of them developed ESRF. The adverse effects included infection (13%), thrombosis (3%), avascalar necrosis (3%), diabetes mellitus (4%) and skin cancer (1% ). Conclusion :The rate of patient and renal survival was high in this group of patients with MLN. The severe tubular-interstitial lesions, nephrotic range proteinuria, and continuous without remission were high risks to develop ESRF.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2007年第1期14-18,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
狼疮性肾炎
人肾存活率
肾小管间质病变
蛋白尿
lupus nephritis patient and survival rate tubular-interstitial lesion proteinuria