LONG-TERM FOLLOW-UP OF PATIENTS WITH LUPUS NEPHRITIS - A STUDY BASED ON THE CLASSIFICATION OF THE WORLD-HEALTH-ORGANIZATION
LONG-TERM FOLLOW-UP OF PATIENTS WITH LUPUS NEPHRITIS - A STUDY BASED ON THE CLASSIFICATION OF THE WORLD-HEALTH-ORGANIZATION
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DOI：
10.1016/0002-9343(87)90645-0
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发表时间：
1987-11-01
影响因子：
5.9
通讯作者：
ESTES, D
中科院分区：
文献类型：
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作者：
APPEL, GB;COHEN, DJ;ESTES, D
对56例系统性红斑狼疮患者的长期病程进行了评估，并通过寿命表分析进行了分析。这些患者在1976年之前进行首次肾活检时具有精确的肾组织学定义并仔细评估了临床状态。自首次活检以来，平均随访时间已超过10年。肾小球系膜病变患者（世界卫生组织[WHO] IIA和IIB级）在5年和10年时的肾脏和患者生存率比其他WHO分级患者（III、IV和V）更有利。个体肾脏组织学特征的活动性和慢性性，当结合到一个活动性指数和慢性指数并没有显着预测肾脏生存在这个人群中，也没有高血压或肾功能不全的存在下，在最初的肾活检显着影响肾脏或患者的生存。初次活检时有肾病综合征的患者肾脏存活率低于无肾病综合征的患者。然而，经历肾病综合征缓解的患者在肾脏和患者存活率方面比没有缓解的患者表现更好。通过生命表分析，1973年后进行活检的患者的生存率显著高于在此之前进行活检的患者，尽管各组间的临床特征和WHO组织学相似。我们的数据表明，在最近的研究中，患者生存率的提高可能与更好的支持性治疗和更有选择性地使用免疫抑制剂治疗轻度狼疮肾炎患者有关。
The long-term course of 56 patients with systemic lupus erythematosus who had precisely defined renal histology and carefully assessed clinical status at the time of their initial renal biopsy prior to 1976 was evaluated and analyzed by life-table analysis. The average length of follow-up has now been greater than 10 years since initial biopsy. Patients with mesangial lesions (World Health Organization [WHO] classes IIA and IIB) had a more favorable renal and patient survival at five and 10 years than did patients in the other WHO classes (III, IV, and V). Individual renal histologic features of activity and chronicity when combined into an activity index and a chronicity index did not significantly predict renal survival in this population, nor did the presence of hypertension or renal dysfunction at the time of the initial renal biopsy significantly influence renal or patient survival. Patients with the nephrotic syndrome at initial biopsy had a poorer renal survival than did patients without the nephrotic syndrome. However, patients who experienced a remission of the nephrotic syndrome fared better in terms of both renal and patient survival than did those patients without a remission. By life-table analysis, patient survival was significantly better for patients in whom biopsy was performed after 1973 than for those in whom biopsy was performed prior to that time despite similar clinical features and WHO histology in each group interval. Our data suggest that improved survival for patients in recent studies may relate to better supportive care and more selective use of immunosuppressive therapy in patients with milder forms of lupus nephritis.