狼疮性肾炎患者肾脏远期生存率及影响因素  

Long-term renal outcome of 1814 patients with lupus nephritis

作　　者：杨静[1,2] 梁丹丹[2] 章海涛[2] 刘正钊[2] 乐伟波[2] 周敏林[2] 胡伟新[2] 曾彩虹[2] 刘志红[2] 

机构地区：[1]南京大学临床医学院 [2]南京军区南京总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2014年第5期407-411,406,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：“十二五”国家科技支撑计划课题(2011BAI10B04)

摘　　要：目的:分析狼疮性肾炎(LN)患者的临床特征和肾脏远期预后,并对影响肾脏预后的危险因素进行评估。方法:收集本中心经肾活检明确诊断为LN,随访时间≥1年汉族患者的资料,观察终点为进入终末期肾病(ESRD)。结果:本研究共纳入患者1 814例,其中男性253例(13.9%),女性1 561例(86.1%);肾脏病理改变为Ⅱ型患者127例(7.0%)、Ⅲ型244例(13.5%)、Ⅲ+Ⅴ型202例(11.1%)、Ⅳ型711例(39.2%)、Ⅳ+Ⅴ型284例(15.7%)和Ⅴ型246例(13.6%);LN患者5年、10年、15年、20年和25年肾脏生存率分别为93.1%、87.9%、81.0%、68.3%和58.7%;患者的性别、LN病程、平均动脉压、尿蛋白定量、血清肌酐、血红蛋白、血清补体水平及病理类型是ESRD的独立危险因素。随访指标时间平均尿蛋白和时间平均平均动脉压均为ESRD的独立危险因素,且其预测价值分别高于基线尿蛋白和平均动脉压。结论:结果显示中国汉族LN患者远期预后良好。肾脏预后和病理类型相关,Ⅳ型和Ⅳ+Ⅴ型LN患者肾脏预后最差。病程中应积极控制尿蛋白和血压以减少ESRD的发生。Objective：To observe the long-term renal outcome of Chinese patients with lupus nephritis （LN） and detect risk factors for poor renal outcome. Methodology：The records of all patients with biopsy-proven lupus nephritis followed for at least one year were reviewed. One thousand eight hundred and fourteen patients were included this respective syudy. All patients were pathological classified based on ISN/RPS 2003 classification, 127（7.0%）patients with class Ⅱ , 244（ 13.5%）with class Ⅲ, 202（ 11. 1%）with class Ⅲ＋V, 711（39. 2%）with class IV, 284（ 15.7%）with class IV＋V, 246（ 13.6% ）with class V.The end point was end stage renal disease （ESRD）. Results：They were 253 （13.9%） males and 1 561 （86. 1%） females with an average follow-up times of 93.3＋60. 4 months. The 5-, 10-, 15-, 20-, and 25-year renal survival rates were 93.1%, 87.9%, 81.0%, 68.3%, 58.7%, respectively. Gender, LN duration, mean arterial pressure （MAP）, proteinuria, serum creatinine, hemoglobin, serum complement C4 and pathological classification were independent baseline risk factors for ESRD. Time average proteinuria （TA-Pro） and time average mean arterial pressure （TA-MAP） were both independent follow-up risk factors for ESRD, with better predictive values than baseline proteinuria and MAP respectively. Conclusion：The 10-year and 20-year renal survival rates of LN patients were 87.9% and 68. 3% respectively. Pathological classification was associated with renal outcome, class IV and class IV ＋ V LN predicting poor renal outcome. Control of proteinuria and MAP during follow-up was important for improving renal outcome.

关 键 词：狼疮性肾炎 肾脏生存率 危险因素 时间平均尿蛋白 

分 类 号：R593.242[医药卫生—内科学]