伴新月体形成的狼疮性肾炎的临床病理特征及预后分析

Clinical pathological features and prognosis of lupus nephritis with crescent formation

目的分析伴新月体形成的狼疮性肾炎(lupus nephritis,LN)患者的临床病理特征及预后差异。方法回顾性分析202例经肾活检确诊为狼疮性肾炎的患者,根据新月体比例分为无新月体组89例、新月体比例<25%组65例和新月体比例≥25%组48例,比较3组患者临床病理特点及预后生存率的差异。结果与无新月体组及新月体比例<25%组相比,新月体比例≥25%组患者血肌酐、活动指数(AI)更高,肾球滤过率估测值(eGFR)、血红蛋白更低(P<0.05);伴新月体组患者血尿酸、CKD分期、慢性化指数(CI)及肾小管间质病变程度均高于无新月体组(P<0.05)。Kaplan⁃Meier生存曲线分析结果提示新月体比例≥25%组患者肾脏存活率低于无新月体组(P<0.05);新月体比例≥25%组与新月体比例<25%组两组患者肾脏存活率相比无差异(P>0.05)。多因素Cox回归分析显示血肌酐是狼疮性肾炎患者肾脏不良预后的独立危险因素,而新月体比例不是肾脏预后不良的独立危险因素。结论伴新月体形成的狼疮性肾炎患者临床及病理表现重,易出现肾功能不全,提示新月体形成是病情预后不良的指标之一。

Objective To investigate the clinical pathological features and prognosis of lupus nephritis with crescent formation.Methods A total of 202 patients with lupus nephritis(LN)confirmed by renal biopsy were retrospectively analyzed.All patients were divided into 3 groups according to the proportion of the crescents in renal biopsies as follows:0%,<25%and≥25%.Clinical pathological characteristics and prognostic survival were compared among the three groups.Results Compared with patients with no crescent formation and with crescents proportion<25%,patients with crescents proportion≥25%had higher level of serum creatinine and activity index(AI),lower eGFR and hemoglobin(P<0.05).The serum uric acid,CKD stage,chronic index(CI)and the degree of renal tubulointerstitial lesions in the crescent group were higher than those in the non⁃crescent group(P<0.05).The results of Kaplan⁃Meier survival curve analysis showed that renal survival was significantly lower in patients with crescents proportion≥25%than group without any crescent(P<0.05).But there was no signifi⁃cant difference between crescents proportion<25%group and crescents proportion≥25%group(P>0.05).In addition,serum creatinine was an independent risk factor for poor renal prognosis in patients with LN,while the proportion of crescents was not an independent risk factor for poor renal prognosis after multivariate Cox regression analysis.Conclusion Patients with LN and crescent formation have severe clinical and pathological manifestations and are prone to renal insufficiency,suggesting that crescent formation is one of the indicators of poor prognosis.