临床及肾穿病理参数对狼疮肾炎预后的影响

The prognostic value of clinical and pathological findings in lupus nephritis

目的 研究狼疮肾炎 (LN)患者的临床、实验室及肾穿病理参数对患者生存率 (SR)和肾脏生存率 (RSR)的影响。方法 对 73例作肾活检的LN患者进行随访 ,按WHO关于LN的病理分型进行分类。用Kaplan Maier方法计算SR和RSR。用Cox比例风险模型分析各临床和实验室变量对SR和RSR影响的风险程度。用多变量逐步回归法分析肾穿病理参数对SR和RSR的独立预测价值。结果 73例LN患者 5年的SR和RSR分别为 95 3%和 83 3% ,10年为 78 8%和 6 5 3%。不同病理组间患者SR和RSR的差异无显著性。多变量回归分析表明是否得到早期诊断和血清肌酐水平对SR和RSR均有明显的影响 ,而 2 4h尿蛋白定量水平对RSR的影响明显。肾活检病理参数中 ,RSR的下降与肾脏的慢性病理改变如肾小管的萎缩、肾间质的纤维化、CI >3以及肾小动脉的损伤均明显相关 ,而肾小管的萎缩还与SR的降低显著相关。结论 早期诊断对延长LN的SR和RSR起重要作用。临床上血清肌酐和 2 4h尿蛋白定量的水平是影响预后的最重要指标。

Objective To assess the contribution of clinical,laboratory,and renal biopsy parameters to predicting the disease outcomes in patients with lupus nephritis (LN).Methods Seventy three LN patients who had biopsy were studied for the survival rate (SR) and renal survival rate (RSR).The clinical and laboratory data were collected and analyzed for the risk of SR and RSR with Cox′s model.Renal biopsy variables were assessed to determine whether they contributed additional predictive value for SR and RSR.Results The SR and RSR at 5 and 10 years were 95 3%,78 8%,and 83 3%,65 3%,respectively.The SR or RSR differences among the six WHO classes did not achieve statistical significance.Multivariate analysis showed that failure in early diagnosis and increased serum creatinine (Cr) levels were significantly associated with decreased both SR and RSR,and 24 h urinary protein excretion (24UP) was closely associated with RSR.The presence of interstitial fibrosis,artery lesion and CI>3 on biopsy contributed significantly to the prognostic value of RSR,and the presence of tubular atrophy was associated with decreased both SR and RSR.Conclusion These results indicate that early diagnosis is significantly associated with increased SR and RSR.Cr and 24UP are independent indicators of prognosis in clinical respect.Chronic renal histological features and renal artery lesion serve an additional important role in the assessment of prognosis in patients with LN.