狼疮性肾炎215例影响因素的Logistic回归分析

Influencing factors of 215 cases with lupus nephritis by Logistic regression analysis

目的探讨狼疮性肾炎(LN)患者肾损害的影响因素,为临床患者的预后判断提供依据。方法收集近5年215例LN住院患者14项临床指标进行分析,对38例曾作肾活检的病例进行病理分型与预后分析。结果单因素Logistic回归分析表明,男性、有吸烟史、有高血压病史、24h蛋白尿增加、低蛋白血症、ANA及ds-DNA阳性、反复感染、糖尿病是肾功能损害的危险因素(P<0.05);多因素Logistic回归分析显示24h蛋白尿增加,ANA及ds-DNA阳性,有高血压、糖尿病史,反复感染对肾损害具有显著性意义(P<0.01)。38例肾活检病例中,16例肾功能衰竭,其中14例为病理检查Ⅳ型,占87%。结论高血压、糖尿病对LN肾功能损害有明显的影响,24h蛋白尿程度越严重,对患者预后的改善越不利;病理活检中Ⅳ型预后不良;持续ds-DNA和ANA阳性较阴性效果差,同时反复感染对预后也有一定的影响。

Objective To investigate the factors in patients with renal damage of lupus nephritis（LN） ,and to provide the markers for clinical prognosis and treatment in LN. Methods The information were collected of 14 clinical indicators in 215 cases of hospitalized patients with LN in the last five years,by using the method of plural regression. Renal biopsies of 38 cases were divided according to pathological types and their prognosis were analyzed. Results Male, smoking history, history of hypertension,24h proteinuria increased, hypoproteinemia, ANA and ds-DNA-positive, recurrent infections, diabetes were risk factors for impaired renal function, by univariate Logistic regression analysis （P〈0.05）.The increased 24h proteinuria, ANA and ds-DNA-positive, hypertension, diabetes mellitus, recurrent infections were significantly risk factors to the kidney damage, by multivariate Logistical regression analysis（P〈0.01 ）. Among 38 biopsis, 16 cases had renal failure, and 14 of 16 showed type 1V LN as pathological feature. Conclusion Hypertension, diabetes are significantly the influence factors to the worse prognosis. The more serious 24h proteinuria are, the more unfavorable the prognosis show, patients with type IVLN show worse prognosis. Infections are also very important factors to the prognosis of LN.Compared with the negative group, the continuous positive ds- DNA and ANA group have worse effect on renal dysfunction.