Clinicopathologic characteristics and outcomes of lupus nephritis with positive antineutrophil cytoplasmic antibody
Clinicopathologic characteristics and outcomes of lupus nephritis with positive antineutrophil cytoplasmic antibody
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抗中性粒细胞胞浆抗体阳性狼疮性肾炎的临床病理特征及结局
DOI：
10.1080/0886022x.2020.1735416
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发表时间：
2020-01
期刊：
影响因子：
3
通讯作者：
Zhao Zhanzheng
中科院分区：
文献类型：
--
作者：
Wang Shuai;Shang Jin;Xiao Jing;Zhao Zhanzheng
目的：目的是确定狼疮性肾炎（LN）患者抗中性粒细胞胞浆抗体（ANCA）阳性血清学是否与不同的临床病理特征和结局相关。方法：在我们的回顾性分析中，2013年至2018年期间入组了283例患者。36例ANCA阳性，并将该组与其余247例在活检时确认为ANCA阴性的患者进行比较。结果如下：ANCA阳性LN患者的抗dsDNA抗体滴度和血清肌酐水平高于ANCA阴性LN患者，而血清血红蛋白浓度低于ANCA阴性LN患者。在病理学评价，节段性毛细血管内细胞增生观察到的光学显微镜是显着更常见的ANCA阳性组。这一特征在治疗组中没有显著差异，但ANCA阴性组和ANCA阳性组对治疗的反应有显著差异，缓解率也有显著差异（76.1% vs 69.4%，p < 0.001）。在随访期间，两个不匹配组之间的肾脏替代治疗（RRT）时间和死亡时间存在显著差异（卡方检验，p = 0.041）。多变量考克斯分析显示，神经系统疾病，ANCA阳性，慢性指数（CI）仍然是患者生存的独立危险因素。肺部感染是死亡的主要原因，最常见的是真菌感染。结论：ANCA阳性的LN患者通常表现出较高的抗dsDNA抗体滴度，较低的血清血红蛋白浓度和较差的肾功能比ANCA阴性的LN患者。真菌感染是死亡的主要原因。我们观察到ANCA阳性是患者生存的独立危险因素。
Aims: The aim was to determine whether anti-neutrophil cytoplasmic antibody (ANCA)-positive serology in patients with lupus nephritis (LN) is associated with different clinicopathologic features and outcomes. Methods: In our retrospective analysis, 283 patients were enrolled between 2013 and 2018. Thirty-six patients were ANCA-positive, and this group was compared with the remaining 247 patients who were confirmed as ANCA-negative at the time of biopsy. Results: ANCA-positive LN patients exhibited higher anti-dsDNA antibody titers and serum creatinine levels and lower serum hemoglobin concentrations than ANCA-negative LN patients. On pathological evaluation, segmental endocapillary hypercellularity observed by light microscopy was significantly more common in the ANCA-positive group. This feature was not significantly different in the treatment group, but the response to treatment was significantly different, as was remission (76.1% vs 69.4%, p < 0.001), between the ANCA-negative and ANCA-positive groups. During follow-up, the times to renal replacement therapy (RRT) and death were significantly different between the two unmatched groups (chi-square test, p = 0.041). Multivariate Cox analysis revealed that neurological disorders, ANCA positivity, and the chronicity index (CI) remained independent risk factors for patient survival. Pulmonary infection was the main cause of death and was most often due to fungal infection. Conclusion: ANCA-positive LN patients typically exhibited higher anti-dsDNA antibody titers, lower serum hemoglobin concentrations and worse renal function than ANCA-negative LN patients. Fungal infection was the main cause of death. We observed that ANCA positivity was an independent risk factor for patient survival.
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