摘要
目的探讨在成功的泼尼松和环磷酰胺诱导治疗后,引起弥漫增生型(Ⅳ型)狼疮肾炎复发的预测指标。方法收集弥漫增生型狼疮肾炎病例,将泼尼松和环磷酰胺诱导治疗成功的病例纳入研究对象。记录临床和实验室资料,于治疗开始后6个月时检测患者尿巨噬细胞趋化蛋白(MCP)-1和巨噬细胞集落刺激因子(M-CSF)。追踪治疗后的复发情况。结果共收集到64例诱导治疗成功的病例,经平均(27±3)个月随访,18例(28%)患者发生至少一次肾性复发,其复发的平均时间为(14±4)个月。复发组患者尿MCP-1和M-CSF水平明显高于缓解维持组。尿MCP-1和M-CSF升高,及血C3降低和抗dsDNA抗体阳性均是Ⅳ型狼疮肾炎复发的独立预测因子。有7例患者出现血肌酐倍增(CRX2),肾性复发是CRX2的惟一预测因子。结论尿MCP-1和M-CSF持续升高是Ⅳ型狼疮肾炎复发的独立预测因子。该研究提示监测诱导缓解患者肾组织炎症指标可有利于指导狼疮肾炎的治疗。
Objective Renal flare is an important cause of end stage renal failure in patients with lupus nephritis. However, the information about its predictors, especially, the noninvasive predictors are still controversial. Present study is undertaken to evaluate the new predictors of renal flares after successful prednisone and cyclophosphamide inductive treatment for diffuse proliferative glomerulonephritis （DPGN） in patients with lupus nephritis. Method A single-center cohort of patients with biopsy-proven SLE DPGN who were treated initially with prednisone and cyclophosphamide were studied. Those who responded to inductive treatment were recruited for our study. After six months of the inductive treatment, urinary levels of monocyte chemotatic protein 1（MCP-1） and macrophage colony-stimulatiag factor （M-CSF） were measured by ELISA. Other clinical and laboratory data were collected from .the time of initial treatment and throughout the followup. Results We studied 64 patients （49 women; and 5 men） with SLE DPGN. After a mean follow-up of （27± 3） months, 18 （28%） patients experienced renal flares. The median time to relapse was （14±4） months. Independent predictors of renal flares were high urinary MCP-1 and M-CSF, low C3 level and positive anti-dsDNA after the initially successful treatment. Seven patients developed doubling of the serum creatinine （CRX2） level. The occurrence of renal flares was the only predictor of CRX2. Conclusion High urinary levels of MCP-1 and M-CSF, as well as low C3 level and positive anti-dsDNA after initial remission are the predictors of renal flare in lupus nephritis patients with DPGN. Our results indicate that renal relapse of lupus nephritis is determined by autoimmune and inflammatory factors, and monitoring these parameters may guide us in managing these patients.
出处
《中华风湿病学杂志》
CAS
CSCD
2006年第4期223-227,共5页
Chinese Journal of Rheumatology
