Clinicopathological characteristics and outcomes of patients with ANCA-positive lupus nephritis: a large cohort study from a single Chinese center
Clinicopathological characteristics and outcomes of patients with ANCA-positive lupus nephritis: a large cohort study from a single Chinese center
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ANCA 阳性狼疮性肾炎患者的临床病理特征和结局：来自中国单一中心的大型队列研究
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Yu xueqing
中科院分区：
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作者：
Zhan xiaojiang;Liu qinghua;Hong lingyao;Zhou qian;Chen wei;Yu xueqing
关于狼疮性肾炎（LN）伴抗神经细胞胞浆抗体（ANCA）患者的临床病理学和临床结局数据非常有限。因此，本研究在中国LN患者的大型队列中调查了这些数据。选择1998年1月至2011年12月在中山大学附属第一医院肾活检确诊的狼疮性肾炎患者478例。主要终点是基线血清肌酐加倍、终末期肾病或死亡的复合终点。ANCA阳性率为14.0%（67/478）。在活检时，ANCA阳性患者CRP水平较高，ESR值较高，抗心磷脂抗体阳性率较高。然而，与ANCA阴性患者相比，他们的eGFR值较低，HDL-C，LDL-C和血红蛋白水平较低。ANCA阳性患者2003 ISN/RPS IV级LN患病率较高，核破裂/纤维素样坏死、细胞性肾小球新月体、间质炎症和肾小管萎缩评分较高。中位随访时间为56个月（范围3-162个月），ANCA患者的复合结局无事件生存率显著低于无ANCA患者（P = 0.015）。多因素考克斯回归分析显示，初始血肌酐和CI评分是显著影响主要结局的最重要危险因素。值得注意的是，ANCA与主要结局无关。与ANCA阴性LN患者相比，ANCA阳性LN患者有更严重的肾损伤和更差的长期预后。
Very limited clinicopathological and clinical outcome data are available regarding lupus nephritis (LN) patients with antineutrophil cytoplasmic antibodies (ANCAs). The present study therefore investigated such data in a large cohort of LN patients in China. 478 patients with renal biopsy-proven lupus nephritis diagnosed in The First Affiliated Hospital of Sun Yat-sen University from January 1998 to December 2011 were enrolled. The primary endpoint was the composite of a doubling of baseline serum creatinine, end-stage renal disease, or death. The prevalence of ANCA seropositivity in this cohort was 14.0% (67/478). At the time of biopsy, ANCA-positive patients had higher CRP levels, higher ESR values, and were more frequently positive for anti-cardiolipin antibodies. However, they had lower eGFR values, and lower levels of HDL-C, LDL-C, and hemoglobin when compared with ANCA-negative patients. ANCA-positive patients had a higher prevalence of 2003 ISN/RPS class IV LN, and higher scores for karyorrhexis/fibrinoid necrosis, cellular glomerular crescents, interstitial inflammation, and tubular atrophy. At a median follow-up time of 56 months (range, 3-162 months), the event-free survival rate for a composite outcome was significantly lower among patients with ANCAs than patients without (P = 0.015). Multivariate Cox regression analysis revealed that initial serum creatinine and CI score were the most important risk factors significantly affecting the primary outcome. Notably, ANCA was not independently associated with the primary outcome. Patients with ANCA-positive LN have more severe kidney injury and a worse long-term outcome compared with patients with ANCA-negative LN.