Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XL II:: factors predictive of new or worsening proteinuria
Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XL II:: factors predictive of new or worsening proteinuria
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DOI：
10.1093/rheumatology/kel347
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发表时间：
2007-04-01
期刊：
影响因子：
5.5
通讯作者：
Reveille, J. D.
中科院分区：
文献类型：
--
作者：
Bastian, H. M.;Alarcon, G. S.;Reveille, J. D.
目标.在一个大型多种族的系统性红斑狼疮（SLE）患者队列中确定新发或恶化蛋白尿的预测因素。采用系统性狼疮活动性测量-修订版的分类，对来自多种族美国队列[多数狼疮：自然vs营养（LUMINA）]的529例SLE患者进行了新发或恶化的蛋白尿评估：（1）正常;（2）试纸上微量或1+蛋白尿;（3）2-3+蛋白尿和（4）>= 4+蛋白尿。尿蛋白升高被视为阳性事件访视。在基线（T0）时评估基本人口统计学和社会经济学变量。在阳性事件访视前的访视时评估临床和免疫学变量，包括疾病特征、活动、持续时间、合并症（如高血压和糖尿病）、药物和自身抗体。选择HLA-DR和HLA-DQ等位基因，和FCGR受体多态性进行了评估。数据采用逻辑回归分析和广义估计方程进行分析。在2801次访视中，243例患者（59.1%/93例得克萨斯西班牙裔，37.0%/100例波多黎各西班牙裔，58.0%/181例非洲裔美国人和29.7%/155例白人）新发或恶化蛋白尿，364例阳性事件。年龄较小[比值比（OR）= 1.013，95%可信限（CL）= 1.001-1.024，P < 0.0334]，抗dsDNA HLA-DRB 1 *1503（OR = 1.746，95%CL = 1.573-2.2673，P < 0.0103）是新发或加重蛋白尿的独立预测因素。预测新发或恶化的蛋白尿的因素包括与狼疮肾炎相关的传统因素，如年龄和抗dsDNA，以及HLA-DRB 1 *1503，其先前未被描述与狼疮肾炎、新发或恶化的蛋白尿相关。
Objectives. To determine the factors predictive of new or worsening proteinuria in a large multiethnic cohort of patients with systemic lupus erythematosus (SLE).Methods. Five hundred and twenty-nine SLE patients from a multiethnic US cohort [LUpus in MInorities: NAture versus Nurture (LUMINA)] were evaluated for new or worsening proteinuria using the categories of the Systemic Lupus Activity Measure-Revised: (1), normal; (2), trace or 1+ proteinuria on the dipstick; (3), 2-3+ proteinuria and (4), >= 4+ proteinuria. A rise in urinary protein was considered a positive event visit. Basic demographic and socioeconomic variables were assessed at baseline (T0). Clinical and immunological variables including disease features, activity, duration, comorbidities (such as hypertension and diabetes), medications and autoantibodies were assessed at the visit preceding a positive event visit. Selected HLA-DR and HLA-DQ alleles, and FCGR receptor polymorphisms were assessed. Data were analysed using logistic regression analyses and generalized estimating equations.Results. There were 243 patients (59.1% of 93 Texan Hispanics, 37.0% of 100 Puerto Rican Hispanics, 58.0% of 181 African Americans and 29.7% of 155 Caucasians) with new or worsening proteinuria, and 364 positive events in 2801 visits. Younger age [Odds ratio (OR) = 1.013, 95% confidence limits (CL) = 1.001-1.024, P < 0.0334], anti-dsDNA (OR = 1.554, CL = 1.149-2.100, P < 0.0042), and HLA-DRB1*1503 (OR = 1.746, 95% CL = 1.573-2.2673, P < 0.0103) were found to independently predict the occurrence of new or worsening proteinuria.Conclusion. The factors predictive of new or worsening proteinuria include traditional factors associated with lupus nephritis, such as age and anti-dsDNA, as well as HLA-DRB1*1503, which has not been previously described in association with lupus nephritis, new or worsening proteinuria.