Segmental and Global Subclasses of Class IV Lupus Nephritis Have Similar Renal Outcomes
Segmental and Global Subclasses of Class IV Lupus Nephritis Have Similar Renal Outcomes
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DOI：
10.1681/asn.2011060558
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发表时间：
2012-01-01
影响因子：
13.6
通讯作者：
Berden, Jo H. M.
中科院分区：
文献类型：
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作者：
Haring, Catharina M.;Rietveld, Anke;Berden, Jo H. M.
弥漫性增生性(IV级)狼疮性肾炎的节段性和全局性亚型之间的肾脏结局是否不同尚不清楚。在这项荟萃分析中，我们检索了MEDLINE、EMBASE、五个临床试验登记处的文献，并选择了队列研究和随机对照试验，这些研究使用了2003年国际肾脏病学会和肾脏病理学会对成人狼疮性肾炎的分类。我们的终点是两倍的血清肌酐浓度或ESRD。在纳入最终分析的8项研究中，这一终点的发生率从0%到67%不等。漏斗图和Egger‘s检验并未显示显著的异质性。Meta分析不支持节段性(IV-S)和全局(IV-G)亚类之间肾脏结局的显著差异(IV-G级相对危险度为1.08；95%可信区间为0.68-1.70)。Meta回归分析未显示种族或随访持续时间影响组织学分级与肾脏风险之间的关系。结论：IV-S级和IV-G级狼疮性肾炎患者的血清肌酐浓度倍增率或终末期肾病发生率无差异。
Whether renal outcomes differ between the segmental and global subclasses of diffuse proliferative (class IV) lupus nephritis is unknown. In this meta-analysis, we searched the literature in MEDLINE, EMBASE, five registries of clinical trials, and selected cohort studies and randomized, controlled trials that used the 2003 International Society of Nephrology and Renal Pathology Society classification of lupus nephritis in adult patients. Our endpoint was the composite of doubling of serum creatinine concentration or ESRD. In the eight studies included in the final analysis, the incidence of this endpoint varied between 0% and 67%. A funnel plot and Egger's test did not suggest significant heterogeneity. The meta-analysis did not support a significant difference in renal outcome between the segmental (IV-S) and global (IV-G) subclasses (relative risk for class IV-G versus IV-S, 1.08; 95% confidence interval, 0.68-1.70). Meta-regression did not suggest that ethnicity or duration of follow-up influenced the association between histologic class and renal risk. In conclusion, the rate of doubling of serum creatinine concentration or of ESRD did not differ between patients with class IV-S and those with IV-G lupus nephritis.