狼疮肾炎患者肾脏复发的风险因素及时间分布的长期随访研究

A retrospective study on the risk factors and time distribution of renal recurrence in lupus nephritis patients with long-term follow-up

目的探讨狼疮肾炎(lupus nephritis,LN)患者肾脏复发的风险因素以及时间分布特点。方法回顾性收集2004年1月至2008年12月在东部战区总医院肾内科住院且经肾活检确诊的LN患者的临床、病理以及随访资料。按照入选者发生临床缓解后是否再复发分为复发组和未复发组,比较两组患者临床病理资料的差异。采用多因素Cox比例风险回归模型法分析LN患者肾脏复发的风险因素。用复发风险时间曲线图分析LN患者肾脏复发风险及时间分布。结果共814例LN患者入选本研究,年龄(30.24±10.90)岁,男性112例(13.8%);完全缓解419例(51.5%),部分缓解395例(48.5%);复发组367例,首次肾脏复发时间为治疗缓解后的(3.21±2.70)年。多因素Cox回归分析结果显示,年龄(HR=0.976,95%CI 0.966~0.986,P<0.001)、AI评分(HR=1.039,95%CI 1.013~1.065,P=0.003)、诱导治疗后缓解状态(HR=0.671,95%CI 0.504~0.894,P=0.006)以及诱导治疗后的24 h尿蛋白量(HR=1.297,95%CI 1.115~1.508,P=0.001)、A-dsDNA(HR=1.450,95%CI 1.139~1.846,P=0.003)、补体C3(HR=0.223,95%CI 0.128~0.389,P<0.001)是LN患者诱导治疗后肾脏复发的独立影响因素。复发风险时间曲线图呈单峰状,复发高峰时间在维持治疗后第2年,不同亚组分析结果显示复发时间类似。结论年龄、肾病理AI评分、诱导治疗后缓解状态、24 h尿蛋白量、A-dsDNA及补体C3是LN患者复发的影响因素。LN患者肾脏复发的高峰时间段为维持治疗的第2年。

Objective To explore the risk factors and time distribution of renal relapse in patients with lupus nephritis(LN).Methods Clinical,pathological characteristics and long-term outcomes of LN patients who were diagnosed and followed in Jinling Hospital from January 2004 to December 2008 were retrospectively analyzed.The patients were divided into relapse group and non-relapse group.The differences of clinical pathological characteristics between the two groups were compared.The multivariate Cox proportion risk model was used to analyze the risk factors affecting renal relapse in LN.The risk factors and time distribution of renal relapse were analyzed with annual relapse risk-time curve.Results A total of 814 patients with LN were included in the study,with 419 cases(51.5%)of complete remission and 395 cases(48.5%)of partial remission.The age was(30.24±10.90)years old,and there were 112 males(13.8%).There were 367 patients suffering renal relapse.The time of first renal relapse was(3.21±2.70)years.The results of multivariate Cox regression showed that age(HR=0.976,95%CI 0.966-0.986,P<0.001),renal pathological activity index(AI)score(HR=1.039,95%CI 1.013-1.065,P=0.003),remission status after induction treatment(HR=0.671,95%CI 0.504-0.894,P=0.006),24 h urinary protein quantitation(HR=1.297,95%CI 1.115-1.508,P=0.001),anti-double strand DNA antibody(A-dsDNA,HR=1.450,95%CI 1.139-1.846,P=0.003)and complement C3(HR=0.223,95%CI 0.128-0.389,P<0.001)were correlated with increasing risk of renal relapse in LN.The annual relapse risk profile was unimodal,with a peak period of the second year after maintenance treatment.Similar patterns of relapse were presented in subgroup analysis.Conclusions Age,renal pathological AI score,remission status after induction therapy,24 h urine protein,A-dsDNA and blood complement C3 are the influencing factors for relapse of LN patients.The peak period of renal relapse in patients with LN is in the second year of maintenance therapy.