SYSTEMIC LUPUS-ERYTHEMATOSUS IN PATIENTS WITH END-STAGE RENAL-DISEASE - LONG-TERM FOLLOW-UP ON THE PROGNOSIS OF PATIENTS AND THE EVOLUTION OF LUPUS ACTIVITY
SYSTEMIC LUPUS-ERYTHEMATOSUS IN PATIENTS WITH END-STAGE RENAL-DISEASE - LONG-TERM FOLLOW-UP ON THE PROGNOSIS OF PATIENTS AND THE EVOLUTION OF LUPUS ACTIVITY
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DOI：
10.1016/s0272-6386(12)81017-1
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发表时间：
1990-09-01
影响因子：
13.2
通讯作者：
RUBIN, AL
中科院分区：
文献类型：
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作者：
CHEIGH, JS;KIM, H;RUBIN, AL
我们研究了59例狼疮合并终末期肾病（ESRD）患者的临床病程，以确定其长期预后并描述狼疮活动的演变。研究人群主要是女性（86%）和年轻人（平均年龄27.4岁），他们从透析开始平均观察了6.5年。在透析开始时，只有21例（35.6%）患者有临床活动性系统性红斑狼疮（SLE）。其余患者进展为ESRD，尽管没有临床狼疮活动。55.4%的患者在第一年有明显的狼疮活动，第5年为6.5%，第10年无。在45%的患者中，狼疮活动在进入ESRD时处于临床不活跃状态，并在整个观察期间保持不活跃状态。血清学活性按比例下降，但低于临床活性。从透析治疗开始的第5年和第10年，累计患者生存率分别为81.1%和74.6%；同样，在移植后的第5年和第10年，这一比例为78%。移植后第5年和第10年的存活率分别为60.4%和45.5%。在长达16年的随访中，没有一例患者出现临床狼疮性肾炎复发。14例患者死于感染性或心血管并发症，但没有一例患者死于SLE本身。这项对大量狼疮患者的长期研究证实了我们之前的发现，肾脏疾病发展为ESRD可能是由非免疫机制介导的，也可能是免疫损伤介导的。大多数患者，无论ESRD的治疗模式如何，尽管持续的血清学异常，但狼疮活动仍处于临床静止状态。患者的生存，无论是透析治疗或肾脏移植，是相当的一般透析人群。我们的结论是，在狼疮合并ESRD的患者中，SLE的血清学和临床表达的消退是持续的。狼疮活动的逐步解决允许明智的退出免疫抑制治疗，以及一个有利的长期结果的病人。
We studied the clinical course of 59 lupus patients with end-stage renal disease (ESRD) to determine their longterm prognosis and delineate the evolution of their lupus activity. The study population was predominantly female (86%) and young (mean age, 27.4 years), and they were observed for a mean of 6.5 years from the inception of dialysis. At the time dialysis was initiated, only 21 patients (35.6%) had clinically active systemic lupus erythematosus (SLE). The remaining patients progressed to ESRD despite the absence of clinical lupus activity. Lupus activity was clinically apparent in 55.4% of patients in the first year, 6.5% in the fifth, and none in the tenth year. In 45% of patients, lupus activity was clinically inactive at entry to ESRD and remained inactive throughout the observation period. Serological activity declined proportionally, but to a lesser extent than clinical activity. Cumulative patient survival was 81.1% and 74.6% at the fifth and tenth year, respectively, from the inception of dialysis treatment; similarly it was 78% at the fifth and tenth year after the transplantation. Graft survival was 60.4% at the fifth and 45.5% at the tenth year. No one had recurrence of clinical lupus nephritis in the graft for up to 16 years of follow-up. Fourteen patients died from either infectious or cardiovascular complications, but none from SLE per se. This long-term study with a large number of lupus patients confirms our previous findings that the progression of renal disease to ESRD may be mediated by nonimmunologic mechanisms, as well as immunologic insults. Most patients, regardless of the mode of treatment for ESRD, remain clinically quiescent for lupus activity despite persistent serological abnormalities. Patient survival, either on dialysis treatment or with a kidney transplant, is comparable to that of the general dialysis population. We conclude that in lupus patients with ESRD, regression of serological and clinical expression of SLE is continuous over time. Progressive resolution of lupus activity permits judicious withdrawal of immunosuppressive therapy, as well as a favorable long-term outcome of the patient.