摘要
目的 探讨狼疮肾炎 (LN)肾功能不全病人与肾功能可逆性相关的因素。方法 采用回顾性队列研究策略 ,对 1991— 1999年住院的 173例LN肾功能不全患者进行 6个月的随访。结局因素 :氮质血症者血肌酐下降至 116 μmol/L以下 ,尿毒症者血肌酐下降 5 0 %以上 ,并脱离透析 3个月以上为阳性结局 ,死亡者因其肾功能不可能再恢复 ,因此删失时间为 2 8周。研究因素包括性别、年龄、病程、症状、并发症、狼疮活动指数、各种常规、生化和免疫学检查、药物治疗等 5 1个变量。统计学方法 :采用COX比例危险率回归模型分析。结果 142例 (82 1% )完成随访。 93例 (6 5 0 % )肾功能恢复 (阳性结局 ) ,17例 (12 0 % )死亡。在运用COX回归的多因素分析 ,去除混杂因素影响后 ,仍然显示对LN肾功能不全的肾功能恢复有影响的因素包括 :环磷酰胺 (CTX)治疗 ,性别 ,肾功能不全的病程 ,肾脏大小 ,贫血和血肌酐值。其中CTX治疗可促进肾功能恢复 ,每周剂量≤ 0 2 5 g/m2 时肾功能恢复的危险比 (HR)为 4 41,95 %的可信区间 (CI)为 (1 0 3 ,18 94) ,每周剂量 >0 2 5 g/m2 时的HR为 13 2 9,95 %CI为 (3 11,5 6 82 )。男性HR为 0 5 1,95 %CI为 (0 2 7,0 95 ) ;肾功能不全的病程(月 )的HR为 0 6 8,95 %CI为 (0 5 3,0 87) ;?
Objective To explore the potential clinical predictors associated with the recovery of renal function in new onset azotemia and uremia in patients with lupus nephritis (LN).Methods Factors influencing recovery of renal function in LN patients were examined in a six month retrospective cohort study.Records of a sample of 173 consecutive in patients of recently diagnosed renal failure with LN from 1991 to 1998 were examined.The outcome factor was recovery of renal function (serum creatinine ≤116 μmol/L) in azotemia patients or a 50% reduction of serum creatinine and discontinuation of dialysis in uremic patients,improved for at least three months.The study factors included demographic,clinical,laboratory and therapeutic data.These study factors and outcome variable were analysed with two structured abstracting forms.Results Complete records to assess follow up were available for 142 (82 1%) subjects from the cohort.After 6 months of follow up,93 patients (65 5%) recovered their renal function and 17 (12 0%) died.Afteeon,the following study factors were found to be significantly associated with recovery of renal function:gender,renal dysfunction duration,renal size,anaemia,creatinine and intravenous cyclophosphamide therapy.The hazard ratio(HR)for male was 0 51 and 95%CI (0 27,0 95).The monthly HR for duration of renal failure was 0 68 and 95%CI (0 53,0 87).The HR of anaemia with Hb 80～100 g/L was 0 43 and 95%CI (0 23,0 79).The HR of anaemia with Hb 60～80 g/L was 0 34 and 95%CI (0 19,0 63).The HR of anaemia with Hb<60 g/L was 0 31 and 95%CI (0 14,0 67).The HR for the increase of 100 μmol/L serum creatinine was 0 84 and 95%CI (0 74,0 96).Conclusion Male,longer duration of renal failure,small renal size,anaemia and higher serum creatinine level are all poor predictors of recovery of renal function in LN.Intravenous cyclophosphamide therapy with higher dose could have a pro tective effect on the recovery of renal function in these patients.
出处
《中华风湿病学杂志》
CAS
CSCD
2000年第6期350-353,共4页
Chinese Journal of Rheumatology
关键词
狼疮肾炎
肾功能衰竭
比例危险度模型
Lupus nephritis
Renal failure
Prognosis
Proportional hazards models
