弥漫增殖性狼疮性肾炎患儿预后危险因素分析

Diffuse proliferative lupus nephritis in children:Analysis on its prognostic risk factors

目的探讨儿童弥漫增殖性(Ⅳ型)狼疮性肾炎(lupus nephritis,LN)预后危险因素。方法对57例做肾活检的儿童Ⅳ型LN患者进行随访,按WHO关于LN的病理分型进行分类。将单因素分析P<0.1的临床、实验室检查和治疗模式等因素纳入多因素模型进行逐步Logistic回归分析。结果儿童Ⅳ型LN患者发生慢性肾功能衰竭的危险因素是内生肌酐清除率、治疗无效和肾病综合征型发病。结论对于儿童Ⅳ型LN患者,内生肌酐清除率、治疗无效和肾病综合征发病均为发生慢性肾功能衰竭的危险因素。重要的是发现CTX冲击疗法在预防肾性复发和阻止LN患者进展为慢性肾功能衰竭两方面不能显示出比联合其他免疫抑制剂方案有任何优势。

Objective To investigate the prognostic risk factors of children with diffuse proliferative （IV type） lupus nephritis. Methods Fifty-seven children with IV type lupus nephritis were followed-up. All of them were classified according to WHO pathological typing on lupus nephritis. The variances, such as treatment modalities, clinical and laboratory data, which were selected from mono-factor of （P〈0.1） together reeeired the Logistic regression analysis by stepwise regression method. Results Multivariate logistic regression model showed that creatinine clearance（CrC1）, absence of remission, dropsical nephritis were associated with ehronical renal failure in children with IV type lupus nephritis. Conclusion The risk factors, such as creatinine clearance（CrC1）, absence of remission, dropsical nephritis, are associated with chronic renal failure in children with IV type lupus nephritis. And it is important that CTX pulse therapy does not show any advantages in prevention of recurrence, in stopping LN become chronic renal faiture.