狼疮肾炎患者的缓解情况及其相关因素的队列研究  

Remission and remission-related factors in lupus nephritis patients： a cohort study

作　　者：杨毅[1] 库明 骆冉[1] 曾锐[1] 葛树旺[1] 徐钢[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肾病内科,武汉430030 [2]深圳市第二人民医院肾内科,518053

出　　处：《中华肾脏病杂志》2017年第8期567-572,共6页Chinese Journal of Nephrology

基　　金：基金项目：国家自然科学基金（81470948、81670633、81570667）;国家科技支撑计划（2013BA109806、2015BA112807）

摘　　要：目的通过队列研究分析肾活检为狼疮肾炎（LN）的患者的缓解情况并分析影响缓解的相关因素。方法纳入2011年1月1Et至2016年7月31日在华中科技大学同济医学院附属同济医院经肾穿刺活组织检查确诊为LN的患者进行前瞻性研究，记录患者肾穿刺时相关临床信息，并进行规律随访。生存曲线显示患者的部分缓解率及完全缓解率；采用Log．rank检验比较大量蛋白尿组（24h尿蛋白量≥3．5g）和非大量蛋白尿组（24h尿蛋白量〈3．5g）的缓解率差异。采用单因素和多因素Cox回归分析评估不同时间内部分缓解和完全缓解患者的影响因素。结果纳入115例LN患者，平均年龄31．4岁，其中88．7％为女性。在长达5年的随访中，死亡2例，透析1例。6、12、24、36和48个月的累积完全缓解率依次为18．9％、40．5％、67．3％、79．4％和87．O％；累积部分缓解率依次为33_3％、58．2％、71．5％、84．0％和89．6％。大量蛋白尿组和非大量蛋白尿组部分缓解率差异无统计学意义（HR=1．33，95％CI：0．74～2．43，P=0．341）；非大量蛋白尿组患者累积完全缓解是大量蛋白尿组的2．01倍（HR=2．01，95％CI：1．15～3．34，P=0．014）。多因素Cox回归分析发现肾穿刺时的血清白蛋白水平每增高1g／L，患者完全缓解增加9％（HR=1．09，95％CI：1．01～1．07，P=0．038），部分缓解增加8％（HR=1．08，95％CI：1．01—1．15，P=0．024）。结论约一半LN患者在1年内达到缓解，非大量蛋白尿患者完全缓解率高于大量蛋白尿患者，血清白蛋白是患者缓解的影响因素。Objective To explore prognosis and remission-related factors in lupus nephritis （LN） patients. Methods Patients diagnosed as LN by renal biopsy in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology between Jan 1, 2011 and July 31, 2016 were enrolled. All related baseline clinical data was recorded and regular follow-up was performed. Kaplan-Meier curves was used to analyze partial remission and complete remission rates. Log-rank test was performed to compare remission rates of patients with nephrotic-range proteinuria （24- hour proteinuria≥3.5 g） and without nephrotic- range proteinuria （24- hour proteinuria〈 3.5 g）. Univariate and multivariate Cox regression analyses were performed to evaluate the remission-related factors in different periods. Results A total of 115 patients, with 88.7% female and （31.5±9.5）years mean age, were followed up for up to 5 years. During follow- up period 2 patients died and 1 dialyzed. The 6-, 12-, 24- and 36- and 48-month renal partial remission and complete remission rates were 33.3%, 58.2%, 71.5%, 84.0%, 89.6%, and 18.9%, 40.5%, 67.3%, 79.4%, 87.0%, respectively. Patients without nephrotic-range proteinuria had higher complete remission than patients with nephrotic -range proteinuria （HR=2.01, 95%CI 1.15- 3.34, P=0.014）, but there was no difference in their partial remission （HR=1.33, 95% CI 0.74- 2.43, P=0.341）. Multivariate Cox regression model indicated that every 1 g/L increase in baseline level of serum albumin was associated with increased 8% and 9% risk, respectively, in partial remission （HR=1.08, 95%CI 1.01-1.15, P=0.024） and complete remission （HR= 1.09, 95%CI 1.01-1.07, P=0.038）. Conclusions Around half of LN patients reach remission during 1 year. Patients without nephrotic- range proteinuria have higher complete remission, and serum albumin is a remission-related factors.

关 键 词：狼疮肾炎 缓解 自行 危险因素 队列研究 

分 类 号：R593.242[医药卫生—内科学]