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Ann Rheum Dis:狼疮肾炎1年时缺乏EULAR/ERA-EDTA应答可以预测长期肾脏预后不良

2020-06-08 xiangting MedSci原创

12个月时缺乏EULAR/ERA-EDTA应答可以预测CKD。

狼疮性肾炎(LN)需要慢性肾脏病(CKD)的短期预测终点。这项研究分析了1年时的治疗反应。

研究分析了1970年1月至2016年12月接受肾活检后进行诱导治疗的LN患者。LN的评估采用了国际肾脏病学会/肾脏病理学会(2003)标准以及美国国立卫生研究院(NIH)活动性和慢性指数。肾脏结局为CKD。根据EULAR/欧洲抗风湿病联盟/欧洲肾脏协会-欧洲透析和移植协会(EULAR/ERA-EDTA)指南定义应答:完全应答:蛋白尿<0.5g/24小时,(接近)正常的估算肾小球滤过率(eGFR);部分应答:蛋白尿下降50%以上至亚肾病水平,(接近)正常eGFR;无应答:其他的所有情况。使用Logistic回归分析12个月的应答,使用Cox回归预测CKD。

共研究了381例患者(90.5%为白种人)。治疗12个月后,根据EULAR/ERA-EDTA,分别有58%、26%和16%的患者达到了完全、部分应答和无应答。中位随访10.7年期间(IQR:4.97-18.80),有53例患者出现了CKD。第15年时,在12个月完全应答、部分应答和无应答患者的无CKD生存率分别为95.2%、87.6%和55.4%(p<0.0001)。完全应答和部分应答患者的无CKD生存率没有差异(p=0.067)。12个月时的血肌酐(HR:1.485,95%CI 1.276-1.625)、eGFR(HR 0.967,95%CI 0.957-0.977)和蛋白尿(HR 1.234,95%CI 1.111-1.379)与CKD相关,但在受试者工作特性曲线上没有确定可靠的阈值。在多因素分析中,12个月时无EULAR/ERA-EDTA应答(HR 5.165,95%CI 2.770-7.628)、低C4(HR 1.053,95%CI 1.019-1.089)和持续动脉高压(HR 3.154,95%CI 1.500-4.547)可以独立预测CKD。

12个月时缺乏EULAR/ERA-EDTA应答可以预测CKD。

原始出处:

Gabriella Moroni. Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis. Ann Rheum Dis. 06 June 2020.

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-06-30 沐沐miya

    👍

    0

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2013390, encodeId=1c14201339022, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Thu Sep 17 21:55:20 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1739015, encodeId=ead41e3901591, content=<a href='/topic/show?id=6e566913df' target=_blank style='color:#2F92EE;'>#ERA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6913, encryptionId=6e566913df, topicName=ERA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e36234488643, 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2013390, encodeId=1c14201339022, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Thu Sep 17 21:55:20 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1739015, encodeId=ead41e3901591, content=<a href='/topic/show?id=6e566913df' target=_blank style='color:#2F92EE;'>#ERA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6913, encryptionId=6e566913df, topicName=ERA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e36234488643, 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href='/topic/show?id=10b5825e4aa' target=_blank style='color:#2F92EE;'>#肾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82574, encryptionId=10b5825e4aa, topicName=肾炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84df12331144, createdName=villahu, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537067, encodeId=c577153e06747, content=<a href='/topic/show?id=aaaf653e44' target=_blank style='color:#2F92EE;'>#EDTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6537, encryptionId=aaaf653e44, topicName=EDTA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=328c12785299, createdName=ycmayy, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-06-10 muzishouyi
  7. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
  8. 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href='/topic/show?id=10b5825e4aa' target=_blank style='color:#2F92EE;'>#肾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82574, encryptionId=10b5825e4aa, topicName=肾炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84df12331144, createdName=villahu, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537067, encodeId=c577153e06747, content=<a href='/topic/show?id=aaaf653e44' target=_blank style='color:#2F92EE;'>#EDTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6537, encryptionId=aaaf653e44, topicName=EDTA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=328c12785299, createdName=ycmayy, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-06-10 villahu
  9. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555573, encodeId=ad8c15555e329, content=<a href='/topic/show?id=0d7282e398f' target=_blank style='color:#2F92EE;'>#肾脏预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82739, encryptionId=0d7282e398f, topicName=肾脏预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ca14623751, createdName=zhzhxiang, createdTime=Wed Jun 10 02:55:20 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-06-10 ycmayy
  10. 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