Assessment of a lupus nephritis cohort over a 30-year period
Assessment of a lupus nephritis cohort over a 30-year period
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DOI：
10.1093/rheumatology/ker101
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发表时间：
2011-08-01
期刊：
影响因子：
5.5
通讯作者：
Isenberg, David A.
中科院分区：
文献类型：
--
作者：
Croca, Sara C.;Rodrigues, Teresa;Isenberg, David A.
方法.在1975年至2005年期间，在伦敦大学学院医院随访了156例LN患者。我们根据肾脏受累的识别日期（1975-85年、1986-95年和1996-2005年）将他们分为三组，并在临床、人口统计学和血清学特征以及疾病结局方面进行比较。两组的临床特征相似;然而，随着时间的推移，非裔加勒比（AC）患者的比例和抗ENA抗体的患病率显著上升。5年死亡率在第一个和第二个十年之间下降了60%，在第三个十年保持稳定。5年终末期肾病（ESRD）发生率保持不变。越来越多的肾移植（RTx）得到了令人鼓舞的结果。AC起源与总体预后较差相关。LN是SLE的一种常见并发症，与死亡率和发病率增加相关，尤其是在AC患者中。尽管RTx的结果令人鼓舞，但一旦确定ESRD，预后相对较差，并且在预防其发展方面没有取得任何改善。此外，虽然死亡率显著下降，但10年来一直保持稳定。这些结果表明，我们已经最大限度地发挥了传统疗法的优势，如果要进一步改善，必须开发新的药物治疗方案。
Methods. Between 1975 and 2005, 156 LN patients were followed up at University College Hospital London. We divided them into three groups depending on the date of recognition of renal involvement (1975-85, 1986-95 and 1996-2005) and compared them in terms of clinical, demographic and serological characteristics and disease outcome.Results. Clinical characteristics were comparable between groups; however, the proportion of Afro-caribbean (AC) patients and the prevalence of anti-ENA antibodies rose significantly over time. The 5-year mortality rate decreased by 60% between the first and second decades, remaining stable over the third decade. The 5-year end-stage renal disease (ESRD) rate remained constant. An increasing number of renal transplants (RTx) was performed with encouraging results. AC origin was associated with a poorer overall prognosis.Conclusion. LN, a common complication of SLE, is associated with increased mortality and morbidity, particularly among AC patients. Despite encouraging results for RTx, once ESRD is established the prognosis is relatively poor and no improvement in preventing its development was achieved. Moreover, although a significant decrease in mortality was observed, it has remained stable for 10 years. These results suggest that we have maximized the benefits of conventional therapies and if further improvement is to be achieved, novel drug regimens must be developed.