Treatment with cyclophosphamide delays the progression of chronic lesions more effectively than does treatment with azathioprine plus methylprednisolone in patients with proliferative lupus nephritis
Treatment with cyclophosphamide delays the progression of chronic lesions more effectively than does treatment with azathioprine plus methylprednisolone in patients with proliferative lupus nephritis
复制标题
DOI：
10.1002/art.22449
复制
发表时间：
2007-02-01
影响因子：
--
通讯作者：
Berden, Jo H. M.
中科院分区：
文献类型：
--
作者：
Grootscholten, Cecile;Bajema, Ingeborg M.;Berden, Jo H. M.
客观的。分析环磷酰胺（CYC）或硫唑嘌呤（AZA）联合甲泼尼龙（NIP）脉冲治疗对增殖性狼疮肾炎患者连续活检结果的影响，并评估各种组织病理学和临床参数对疾病结果的预测价值。方法。根据标准化方法对在研究开始时和治疗 2 年后获得的增殖性狼疮性肾炎患者的活检标本进行评分，并根据疾病结果评估结果。结果。在最初入组的 87 名患者中，39 名接受了重复活检。这些患者在入组时和 2 年随访时均代表了整个组。中位活动指数从 8.0 变为 2.7（治疗组之间没有差异）。在AZA加MP治疗组（AZA组）中，中位慢性指数的增加（从2.7至3.8）大于CYC组（从2.7至3.0）（P = 0.050）。在多变量分析中，入组时和 2 年后的肾功能是最后一次就诊时肾功能的最佳预测因子，而没有任何组织病理学变量（无论是在入组时还是在 2 年时）添加到此预测中。将疾病转变为 11 级的患者与患有持续性增殖性狼疮肾炎的患者进行比较，发现治疗组之间在任一时间点都没有差异，并且在 2 年时也没有临床差异。然而，入院时较高的血清肌酐水平和末次就诊时较高的蛋白尿是 2 年后仍患有增殖性狼疮肾炎的患者的特征。结论。这些结果表明，虽然 CYC 和 AZA 都能有效减少狼疮性肾炎的活动性病变，但 CYC 更有效地阻止慢性病变的进展。通过重复活检评估的变量不能预测临床结果。
Objective. To analyze the effect of treatment with either pulse cyclophosphamide (CYC) or azathioprine (AZA) combined with methylprednisolone (NIP), on serial biopsy results in patients with proliferative lupus nephritis, and to evaluate the predictive value of various histopathologic and clinical parameters with regard to disease outcome.Methods. Biopsy specimens from patients with proliferative lupus nephritis, obtained at study entry and after 2 years of therapy, were scored according to a standardized method, and results assessed in relation to disease outcome.Results. Of the 87 patients originally enrolled, 39 underwent repeat biopsy. These patients were representative of the overall group, both at entry and at 2-year followup. The median activity index changed from 8.0 to 2.7 (no differences between the treatment groups). In the group treated with AZA plus MP (AZA group), the increase in the median chronicity index (from 2.7 to 3.8) was larger than that in the CYC group (from 2.7 to 3.0) (P = 0.050). In multivariate analyses, renal function at enrollment and after 2 years was the best predictor of renal function at the last visit, while none of the histopathologic variables (either at entry or at 2 years) added to this prediction. Comparing patients whose disease transitioned to class 11 with those who had persistent proliferative lupus nephritis revealed no differences between the treatment groups at either time point, and no clinical differences at 2 years. However, a higher serum creatinine level at entry and greater proteinuria at last visit were characteristic of patients who still had proliferative lupus nephritis at 2 years.Conclusion. These results indicate that, although both CYC and AZA are effective in reducing active lesions in lupus nephritis, progression of chronic lesions is more effectively halted by CYC. Variables assessed by repeat biopsy do not predict clinical outcome.