刘婷婷, 杨毅, 代维, 李月强, 韩敏, 何晓峰, 葛树旺, 徐钢. 非大量蛋白尿狼疮肾炎患者肾脏病理严重程度的危险因素分析[J]. 临床肾脏病杂志, 2019, 19(1): 1-7. DOI: 10.3969/j.issn.1671-2390.2019.01.001
    引用本文: 刘婷婷, 杨毅, 代维, 李月强, 韩敏, 何晓峰, 葛树旺, 徐钢. 非大量蛋白尿狼疮肾炎患者肾脏病理严重程度的危险因素分析[J]. 临床肾脏病杂志, 2019, 19(1): 1-7. DOI: 10.3969/j.issn.1671-2390.2019.01.001
    shu
    LIU Ting-ting, YANG Yi, DAI Wei, LI Yue-qiang, HAN Min, HE Xiao-feng, GE Shu-wang, XU Gang. Renal pathology-related factors in non-nephrotic-range proteinuria of lupus nephritis patients[J]. Journal of Clinical Nephrology, 2019, 19(1): 1-7. DOI: 10.3969/j.issn.1671-2390.2019.01.001
    Citation: LIU Ting-ting, YANG Yi, DAI Wei, LI Yue-qiang, HAN Min, HE Xiao-feng, GE Shu-wang, XU Gang. Renal pathology-related factors in non-nephrotic-range proteinuria of lupus nephritis patients[J]. Journal of Clinical Nephrology, 2019, 19(1): 1-7. DOI: 10.3969/j.issn.1671-2390.2019.01.001
    shu

    非大量蛋白尿狼疮肾炎患者肾脏病理严重程度的危险因素分析

    Renal pathology-related factors in non-nephrotic-range proteinuria of lupus nephritis patients

      摘要
    • 摘要: 目的 研究影响非大量蛋白尿（24h蛋白尿<3.5 g）狼疮肾炎（LN）患者肾脏病理严重程度的危险因素以及预后情况。方法 纳入2004年1月1日至2018年3月31日于华中科技大学同济医学院附属同济医院行肾脏穿刺活检确诊为LN并且起始24h蛋白尿<3.5 g的患者作为研究对象，记录患者肾活检时相关临床信息，并行规律随访。对所有患者肾活检时的病理切片进行重新阅片，采用统一标准进行评分，根据患者肾脏病理严重程度分为病理轻组和病理重组。采用Log-rank检验比较两组的缓解率差异。采用Logistic回归方程分析影响非大量蛋白尿LN患者肾脏病理严重程度的危险因素。结果 共纳入95例非大量蛋白尿LN患者，以女性为主，平均年龄（32.4±1.1）岁，其中有随访者共79人。肾脏病理轻组43例，肾脏病理重组52例，病理轻组患者血红蛋白、血清IgA水平均高于病理重组（P<0.05），而血氯水平显著低于病理重组（P<0.05）。随访结果显示，病理轻组患者的远期（大于6个月）累积完全缓解率大于病理重组（P<0.05）。多因素Logistic回归结果提示，年龄（OR=1.219，95% CI：1.043~1.425，P<0.05）、SLEDAI-2K评分（OR=1.202，95% CI：1.025~1.411，P<0.05）、起始蛋白尿定量（OR=3.793，95% CI：1.058~13.595，P<0.05）、血清IgA水平（OR=0.222，95% CI：0.063~0.781，P<0.05）是肾脏病理重的独立危险因素。结论 老龄、高SLEDAI-2K评分、高起始蛋白尿定量和低血清IgA水平可能与非大量蛋白尿LN患者的肾脏病理较重相关。

       

      Abstract: Objective To explore the renal pathology-related factors of non-nephrotic-range proteinuria of biopsy-proven lupus nephritis (LN) patients and their prognosis. Methods We prospectively observed non-nephrotic-range proteinuria patients with biopsy-proven LN in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology between Jan. 1, 2004 and July 31, 2018. All related baseline clinical data were recorded and regular follow-up was performed. The pathological sections of all patients were re-read and scored according to uniform criteria. According to the severity of renal pathology, the patients were divided into two groups:mild pathologic damage group and severe pathologic damage group. Log-rank test was used to compare the difference of remission rate between the mild pathologic damage group and severe pathologic damage group. Logistic regression equation was used to analyze the renal pathology-related risk factors.Results Ninety-five non-major proteinuria LN patients (female:83.2%, mean age:32.4 years) were enrolled, including 79 follow-ups. There were 43 cases of mild renal pathologic damage group and 52 cases of severe renal pathologic damage group. Hemoglobin and serum IgA levels were significantly higher in mild pathologic group than in severe pathologic damage group (P<0.05). The follow-up results showed that the cumulative complete remission rate in the mild pathologic damage group was significantly higher than that in the severe pathologic damage group (P<0.05). Multivariate logistic regression results indicated age (OR=1.219, 95% CI:1.043 to 1.425, P<0.05), SLEDAI-2K score (OR=1.202, 95% CI:1.025 to 1.411, P<0.05), initial proteinuria (OR=3.793, 95% CI:1.058 to 1.595, P<0.05), and serum IgA levels (OR=0.222, 95% CI:0.063 to 0.781, P<0.05) were independent renal pathology-related risk factors. Conclusions Older, high SLEDAI-2K scores,high initial proteinuria and low serum IgA levels may be associated with severe renal pathologic damage in patients with non-nephrotic-range proteinuria LN.

       

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