弥漫增生型狼疮性肾炎的远期预后  

Long-term outcome of patients with diffuse proliferative lupus nephritis

作　　者：孙海鸥[1] 胡伟新[2] 谢红浪[2] 章海涛[2] 陈惠萍[2] 曾彩虹[2] 刘志红[2] 黎磊石[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2008年第3期216-223,共8页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:回顾性分析弥漫增生型狼疮性肾炎(DPLN)的远期预后及影响预后的因素。方法:临床符合SLE,经肾活检存在弥漫增生性病变的狼疮性肾炎(Ⅳ/Ⅳ+V,ISN/RPS2003肾脏病理分型标准)患者441例[女性377例,男性64例,平均年龄(29.6±9.85)岁]。通过Kaplan-Meier法估算人肾存活率,并建立COX风险模型,分析影响预后的危险因素。结果:(1)人、肾存活率:441例平均随访(60.8±43.3)个月(中位时间61个月)。共15例(3.4%)死亡(感染11例,脑血管意外2例,肺出血1例,猝死1例),5年、10年人存活率分别为96.5%和92%;共28例(6%)在随访期间进展至终末期肾病(endstageranaldisease,ESRD),5年、10年肾存活率分别为94.5%和86.4%。随访初SCr≥132.6μmol/L(HR6.54)、慢性化指数(CI)≥3(HR3.52)、伴有血管病变(HR10.37)及V型病变(HR2.80)、治疗未获缓解(HR10.22)及复发(HR6.13)是肾脏进入ESRD的独立危险因素。(2)1999至2003年DPLN患者5年人、肾存活率均高于1993至1998年(分别为96.3%vs93.6%;95.7%vs90%,P>0.05),但未达统计学差异;(3)复发及转型:323例(73.2%)在随访(7.6±8.5)月(中位时间5月)时达缓解,139例(31.5%)平均随访(35.4±28.2)月(中位时间26月)时复发,5年累积复发率达34.7%。71例因治疗未缓解或复发行重复肾活检,其中17例(23.9%)发生转型(Ⅳ型转为Ⅳ+V型)。(4)并发症:共发生并发症270例次(61.2%),主要包括感染(21.3%),月经紊乱(20.2%),股骨头坏死(5.4%),肝酶升高(4.5%)等,5年累积无并发症发生率56.7%。结论:本组DPLN5年人肾存活率可达90%,但复发率及并发症发生率高。随访初合并血管病变、肾功能不全、肾组织慢性化损伤严重、治疗未缓解及复发进入ESRD风险增大。感染仍为主要死因。提高缓解率、降低复发率及减少并发症仍是重型LN临床研究重点。Objective ：To retrospectively analyze the long-term outcome of patients with diffuse proliferative lupus nephropathy （DPLN） and prognostic factors. Methodology：Four hundred and forty-one Chinese patients （females 377 and males 64 with mean of 29.6±9.85 years old） with biopsy-proven DPLN （ISN/RPS2003 classification criteria） were collected in this study. The patient and renal survival was estimated by Kaplan-Meier method. Cox proportional hazards regression analysis was used to assess the risk factors associated with end stage renal disease （ESRD）. Results： All patients were followed for （60.8±43.3） months with the median of 61 months. 15 patients died, and the patient survival at 5 and 10 year was 96.5% and 92% respectively. 28 cases developed ESRF, the renal survival at 5 and 10 year was 94.5% and 86. 4% respectively. Baseline serum creatinine （SCr）≥132.6μmol/L （ HR 6. 54）, renal CI ≥3 （ HR 3.52 ）, AI ≥ 10 （ HR 2. 10）, with renal vascular lesion （ HR 10. 37 ） or type V lesion （ HR 2. 80）, and no remission after induction treatments （ HR 10. 22） or relapse during follow-up （ HR 6.13 ） were independent risk factors for developing ESRD. 71 patients was performed re-biopsy because of no remission after the induction treatment or relapse during mainte- nance period, among them 17 （23.9%） showed renal histological transformation from class IV to class IV ＋ V. Adverse effects included infection （ 21.3% ）, menstrual disorders （ 20. 2% ）, elevation of liver enzyme （ 4. 5% ）, leucopenia （2.7%）, diabetes mellitus （2. 3% ）, hypersensitiveness （ 1.4% ） , psychiatric symptom （0.9%）, avascular necrosis （5.4%）, deep vein thrombosis （0. 9% ）, and upper gastrointestinal hemorrhage （0. 7% ）, skin cancer （0. 2% ） and mesothelial cell tumor （0. 2% ）. Conclusion：Long-term patient and renal survival rate were high in this group of patients with DPLN. The patients with renal vascular lesion, no remission after indu

关 键 词：狼疮性肾炎 人/肾存活率 预后 

分 类 号：R593.242[医药卫生—内科学] R542.22[医药卫生—临床医学]