PROGNOSTIC-SIGNIFICANCE OF SUBEPIDERMAL IMMUNE DEPOSITS IN UNINVOLVED SKIN OF PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS - A 10-YEAR LONGITUDINAL-STUDY
PROGNOSTIC-SIGNIFICANCE OF SUBEPIDERMAL IMMUNE DEPOSITS IN UNINVOLVED SKIN OF PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS - A 10-YEAR LONGITUDINAL-STUDY
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DOI：
10.1111/1523-1747.ep12340246
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发表时间：
1984-01-01
影响因子：
6.5
通讯作者：
GILLIAM, JN
中科院分区：
文献类型：
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作者：
DAVIS, BM;GILLIAM, JN
系统性红斑狼疮（SLE）患者临床正常皮肤表皮下免疫沉积物的直接免疫荧光检测已成为阳性狼疮带试验（LBT）。为了更好地了解LBT与SLE预后之间的关系，对51例SLE患者进行了为期10年的前瞻性纵向研究。从这51例患者的前臂掌侧内侧临床正常皮肤中获得了总共223个LBT（平均每例患者4.4个），结果与疾病的临床病理特征和结果相关。最初的LBT结果（在没有系统治疗的情况下获得）用于将患者分为LBT阳性组和LBT阴性组。除了随后用每日剂量> 40 mg的泼尼松或细胞毒性剂治疗的患者外，LBT阳性组中的患者通常保持LBT阳性。LBT阴性患者在重复检测中通常保持LBT阴性。两组临床特征的比较显示，LBT阳性组狼疮性肾病的患病率为55%，而LBT阴性组为23%（P = 0.025）。虽然两组在初始LBT时的血清肌酐水平相似，但LBT阳性组的最大血清肌酐（平均值为3.0 mg/dl）显著高于LBT阴性组的最大值（平均值为1.2 mg/dl）（P = 0.04）。LBT阴性组中仅9%的肾活检显示弥漫性增生性肾小球肾炎，而LBT阳性组中65%的肾活检显示弥漫性增生性肾小球肾炎（P = 0.007）。比较两组的结果; LBT阴性组从诊断时起的10年生存率为95%，而LBT阳性组仅为54%（P = 0.007）。阳性LBT具有预测价值，因为它可以识别出一部分SLE患者，这些患者具有更严重的肾脏疾病，长期生存率显著降低。
The detection by direct immunofluorescence of subepidermal immune deposits in clinically normal skin of patients with systemic lupus erythematosus [SLE] has become a positive lupus band test (LBT). To gain a better understanding of the relation between the LBT and prognosis in SLE a prospective longitudinal study was carried out in 51 SLE patients covering a 10-yr period. A total of 223 LBT were obtained from clinically normal skin of the medial volar forearm on these 51 patients (average, 4.4 per patient) and the results correlated with clinicopathologic features of the disease and outcome. Findings from the initial LBT (obtained while on no systemic therapy) were used to divide patients into LBT-positive and LBT-negative groups. With the exception of patients subsequently treated with daily doses of prednisone > 40 mg or cytotoxic agents, the patients in the LBT-positive group usually remained LBT-positive. The LBT-negative patients usually remained LBT-negative on repeated testing. A comparison of clinical features in the 2 groups revealed a 55% prevalence of lupus nephropathy in the LBT-positive group as opposed to 23% in the LBT-negative group (P = 0.025). Although the 2 groups had similar serum creatinine levels at the time of the initial LBT, the maximum serum creatinine (mean, 3.0 mg/dl) in the LBT-positive group was significantly higher than the maximum (mean, 1.2 mg/dl) in the LBT-negative group (P = 0.04). Only 9% of renal biopsies in the LBT-negative group showed diffuse proliferative glomerulonephritis in contrast to 65% of biopsies in the LBT-positive group (P = 0.007). The 2 groups were compared with regard to outcome; 10-yr survival from the time of diagnosis was 95% in the LBT-negative group as opposed to only 54% in the LBT-positive group (P = 0.007). A positive LBT has predictive value in that it identifies a subset of SLE patients with more aggressive renal disease and significantly decreased long-term survival.