Validation of the Lupus Nephritis Clinical Indices in Childhood-Onset Systemic Lupus Erythematosus.
Validation of the Lupus Nephritis Clinical Indices in Childhood-Onset Systemic Lupus Erythematosus.
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DOI：
10.1002/acr.22651
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发表时间：
2016-02
影响因子：
4.7
通讯作者：
Brunner HI
中科院分区：
文献类型：
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作者：
Mina R;Abulaban K;Klein-Gitelman MS;Eberhard BA;Ardoin SP;Singer N;Onel K;Tucker L;O'neil K;Wright T;Brooks E;Rouster-Stevens K;Jung L;Imundo L;Rovin B;Witte D;Ying J;Brunner HI
根据肾活检结果的标准，验证儿童狼疮性肾炎（LN）活动和损害的临床指标。在83例需要肾活检的儿童中，测量了SLE疾病活动指数肾区（SLEDAI-R）、不列颠群岛狼疮评估组肾区指数（BILAG-R）、系统性狼疮国际合作临床肾活动指数（SLICC-RAS）和肾区损伤指数（SDI-R）。采用固定效应和逻辑模型预测国际肾脏病学会/肾脏病理学会（ISN/RPS）分级;低/中度vs.高LN活性[NIH活性指数（NIH-AI）评分：≤ 10 vs.> 10;肾小管间质活性指数（TIAI）评分：≤ 5 vs.> 5）或无vs.存在LN慢性[NIH慢性指数（NIH-CI）评分：0 vs. ≥ 1]。I/II级、III/IV级和V级患者分别为10例、50例和23例。ISN/RPS分类的临床指标评分未区分患者。SLEDAI-R和SLICC-RAS而不是BILAG-R与NIH-AI评分定义的LN活动状态不同，而基于TIAI评分的LN活动状态之间仅SLEDAI-R评分不同。SDI-R诊断LN慢性化的敏感性和特异性分别为23.5%和91.7%。尽管SLICC-RAS和SLEDAI-R评分旨在测量LN活性，但其与LN慢性状态存在显著差异。目前LN的临床指标不能区分儿童ISN/RPS类型。尽管存在缺点，SLEDAI-R似乎最适合在临床环境中测量LN活性。SDI-R与LN慢性化的相关性较差。
To validate clinical indices of lupus nephritis (LN) activity and damage when used in children against the criterion standard of kidney biopsy findings. In 83 children requiring kidney biopsy the SLE Disease Activity Index Renal Domain (SLEDAI-R); British Isles Lupus Assessment Group index Renal Domain (BILAG-R), Systemic Lupus International Collaborating Clinics Renal Activity (SLICC-RAS) and Damage Index Renal Domain (SDI-R) were measured. Fixed effect and logistic models were done to predict International Society of Nephrology/Renal Pathology Society (ISN/RPS) class; low/moderate vs. high LN-activity [NIH Activity Index (NIH-AI) score: ≤ 10 vs. > 10; Tubulointerstitial Activity Index (TIAI) score: ≤ 5 vs. > 5) or the absence vs. presence of LN chronicity [NIH Chronicity Index (NIH-CI) score: 0 vs. ≥ 1]. There were 10, 50 and 23 patients with class I/II, III/IV and V, respectively. Scores of the clinical indices did not differentiate among patients by ISN/RPS class. The SLEDAI-R and SLICC-RAS but not the BILAG-R differed with LN-activity status defined by NIH-AI scores, while only the SLEDAI-R scores differed between LN-activity status based on TIAI scores. The sensitivity and specificity of the SDI-R to capture LN chronicity was 23.5% and 91.7%, respectively. Despite designed to measure LN-activity, SLICC-RAS and SLEDAI-R scores significantly differed with LN chronicity status. Current clinical indices of LN fail to discriminate ISN/RPS Class in children. Despite its shortcomings, the SLEDAI-R appears to best for measuring LN activity in a clinical setting. The SDI-R is a poor correlate of LN chronicity.