狼疮肾炎终末期狼疮活动情况和预后的观察

A study of the end stage of lupus nephritis about activity and prognosis

目的探讨狼疮肾炎（ＬＮ）患者发展至终末期肾病（ＥＳＲＤ）时狼疮活动情况和预后的关系。方法分析１９８７～１９９７年资料完整的７１例ＬＮ的ＥＳＲＤ患者临床性ＳＬＥ活动和血清学ＳＬＥ活动的各项指标、死亡原因，分析比较ＬＮ的ＥＳＲＤ患者与非ＬＮ的ＥＳＲＤ患者的存活率。结果本组ＬＮ的ＥＳＲＤ患者在进行透析治疗前有６４８％已没有ＳＬＥ临床活动表现。进行透析治疗后，ＳＬＥ临床性活动渐趋静止状态，活动率从第一年５６３％下降至第十年２８％；ＳＬＥ血清学活动表现的消退，要比临床活动表现的消退缓慢；ＬＮ的ＥＳＲＤ透析治疗患者第２、５、１０年的存活率与非ＬＮ透析患者相近，分别为７９６％、５２５％、３０５％，其死亡原因似与ＳＬＥ活动无关。结论在ＬＮ的ＥＳＲＤ期间，ＳＬＥ活动的静止趋势与时俱增，死亡原因与ＳＬＥ活动性似无明显关系，ＬＮ的ＥＳＲＤ替代治疗患者的预后与非ＬＮ的ＥＳＲＤ替代治疗患者相同。当ＬＮ发展至不可逆的ＥＳＲＤ时，需长期作肾脏替代治疗，无必要再应用免疫抑制治疗。

Objective To study the relationship between the lupus active condition and prognosis on end stage renal disease(ESRD)of lupus nephritis(LN). Methods The complete clinical informations of 71 cases,from 1987 to 1997,with ESRD of LN were analysed,including clinical,serological index of lupus activity and the cause of death.The survival rate of LN ESRD was compared with that of NonLN ESRD. Results 648% LN patients lost their clinical activity before receiving dialysis.A decline tendency was observed in clinical activity.The scale of lupus activity decreased from 563% in the first year to 28% in the 10th year.The regression of serological activity was slower than that of clinical manifestation.The survival rate of LNESRD in 2,5,10year was 796%,525% and 305%respectively,which was close to nonLN ESRD.The death cause of LN ESRD seemed no association with the activity of systemic lupus erythematosus. ConclusionBZDuring ESRD,the quiescent tendency of lupus activity is obvious.Lupus activity is not the death cause of LN ESRD.There is no difference in the prognosis between LN ESRD and nonLN ESRD.Therefore,it is necessary for those patients with renal failure without reversibility to get longterm dialysis,and there is also no need to use immunosuppressive treatment.