Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: a multicenter retrospective study of a Japanese cohort
Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: a multicenter retrospective study of a Japanese cohort
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DOI：
10.1186/s13075-020-02271-3
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发表时间：
2020-07-22
影响因子：
4.9
通讯作者：
Kawakami, Atsushi
中科院分区：
文献类型：
--
作者：
Ichinose, Kunihiro;Kitamura, Mineaki;Kawakami, Atsushi
背景 大多数系统性红斑狼疮 (SLE) 患者在 SLE 诊断后 5 年内进展为狼疮性肾炎 (LN)，尽管 LN 在较晚时间点发生的情况并不少见。在此，我们评估了早发型和晚发型 LN 的临床特征。患者和方法我们回顾性分析了 1990 年至 2016 年间在长崎大学医院和相关社区医院接受肾活检并被诊断为 LN 的 201 例患者中的 184 例。早发型定义为患者 SLE 诊断后 5 年内出现 LN，晚发型定义为诊断后 > 5 年出现 LN。我们分析了诱导治疗后 6 个月和 12 个月时的完全肾脏反应 (CR)、肾脏病理学的分类以及早发和晚发 LN 组的死亡率。结果 肾活检后的平均随访时间为 123 +/- 85 个月。早发患者113例（61.4%），晚发患者71例（38.6%）。多变量分析显示，以下因素可预测 CR：6 个月时：女性（比值比 [OR] 3.93，95% 置信区间 [CI] 1.31-11.77，p = 0.010）、蛋白尿（OR 0.83，95% CI 0.71-0.97，p = 0.009）、活动指数（0-24）（OR 0.83，95% CI 0.70-0.99，p = 0.030）和早发性 LN（OR 2.39，95% CI 1.15-4.98，p = 0.018）； 12 个月时：女性（OR 3.60，95% CI 1.32-9.83，p = 0.013），混合 LN（OR 0.18，95% CI 0.04-0.80，p = 0.024），活动指数（0-24）（OR 0.80，95% CI 0.68-0.94，p = 0.007）和早发性 LN（OR 2.10，95% CI 1.05-4.23，p = 0.035）。在 Cox 比例风险和 Fine-Gray 回归模型中，早发性 LN 组的死亡率显着高于晚发性 LN 组（分别为 p = 0.038 和 p = 0.043）。结论 在我们的队列中，早发性 LN 比晚发性 LN 更能预测 6 个月和 12 个月时的 CR。我们的结果表明，早发性 LN 患者的死亡率低于晚发性 LN 患者。
Background Most patients with systemic lupus erythematosus (SLE) progress to lupus nephritis (LN) within 5 years of their SLE diagnosis, although it is not uncommon for LN to develop at later time points. Here we evaluated the clinical features of early- and late-onset LN. Patients and methods We retrospectively analyzed the cases of 184 of the 201 patients who underwent a renal biopsy at Nagasaki University Hospital and associated community hospitals between 1990 and 2016 and were diagnosed as having LN. Early onset was defined as the development of LN within the first 5 years after the patient's SLE diagnosis, and late onset was defined as LN development > 5 years post-diagnosis. We analyzed the complete renal response (CR) at 6 and 12 months after induction therapy, the classification of renal pathology, and the mortality of the early- and late-onset LN groups. Results The mean follow-up duration after the renal biopsy was 123 +/- 85 months. There were 113 (61.4%) early-onset patients and 71 (38.6%) late-onset patients. A multivariate analysis revealed that the following factors were predictive of CR: at 6 months: female sex (odds ratio [OR] 3.93, 95% confidence interval [CI] 1.31-11.77,p = 0.010), proteinuria (OR 0.83, 95% CI 0.71-0.97,p = 0.009), index of activity (0-24) (OR 0.83, 95% CI 0.70-0.99,p = 0.030), and early-onset LN (OR 2.39, 95% CI 1.15-4.98,p = 0.018); at 12 months: female sex (OR 3.60, 95% CI 1.32-9.83,p = 0.013), mixed LN (OR 0.18, 95% CI 0.04-0.80,p = 0.024), index of activity (0-24) (OR 0.80, 95% CI 0.68-0.94,p = 0.007), and early-onset LN (OR 2.10, 95% CI 1.05-4.23,p = 0.035). In a Cox proportional hazards and Fine-Gray regression model, the early-onset LN group had a significantly better mortality rate than the late-onset LN group (p = 0.038 andp = 0.043, respectively). Conclusions In our cohort, early-onset LN was a better predictor of CR at 6 and 12 months than late-onset LN. Our results suggest that early-onset LN patients had lower mortality than late-onset LN patients.