摘要
目的研究分析真实世界背景下初发系统性红斑狼疮患者中狼疮性肾炎患者和非狼疮性肾炎患者在临床特点、治疗方案和短期预后上的差异。方法回顾性分析2018年1月至2023年1月在蚌埠医科大学第一附属医院风湿免疫科确诊的249例初发SLE患者病例资料。根据确诊SLE时有无肾脏受累分为LN组(79例)和non-LN组(170例),对两组间的临床特点、治疗及随访情况进行比较分析。结果249例初发SLE患者确诊时LN发生率为31.7%(79例)。LN组与non-LN组在女性占比、起病年龄、诊断年龄和病程上差异无统计学意义(均P>0.05)。LN组患者在血红蛋白、血小板计数、血清白蛋白、补体C3和补体C4水平上低于non-LN组(均P<0.05)。LN组关节炎的发生率低于non-LN组,感染、胸膜炎和心包炎的发生率高于non-LN组(均P<0.05)。LN组抗ds DNA抗体、抗SSB抗体的阳性率高于non-LN组(均P<0.05)。LN组SLEDAI-2000评分高于non-LN组(13.2分vs.7.4分,P<0.001),但非肾脏SLEDAI-2000评分低于non-LN组(5.7分vs.7.4分,P=0.007),SLEDAI-2000评分重度患者比例高于non-LN组,评分轻度患者比例低于non-LN组(60.8%vs.12.9%,13.9%vs.55.3%,均P<0.001)。在诱导治疗中,LN组54例(80.6%)和non-LN组80例(56.7%)接受了包括生物制剂在内的免疫抑制剂治疗(80.6%vs.56.7%,P<0.001)。LN组治疗12个月内感染不良事件发生率高于non-LN组(28.4%vs.16.3%,P=0.043)。在随访期间,LN组患者治疗12个月比治疗6个月时的肾脏总体缓解率高,治疗12个月时完全肾脏反应43例(64.2%),部分肾脏反应22例(32.8%),肾脏无治疗反应2例(3.0%),其血红蛋白、血小板计数、血清白蛋白、补体C3和补体C4水平较治疗前好转(均P<0.001)。两组患者在死亡、并发肿瘤等相关随访结局上差异无统计学意义(均P>0.05)。两组患者达到狼疮低疾病活动状态或缓解状态的比例和时间差异无统计学意义,在狼疮疾病活动复发上的比例和时间无显著差异(均P>0.05)。结论在初发SLE患者中,LN患者心包炎、胸膜炎和感染的发生率更高,Anti-ds DNA和Anti-SSB的阳性率更高,肾脏外疾病活动度、关节炎发生率和血清白蛋白水平更低。LN患者诱导治疗12个月时肾脏总体缓解率和相关实验室指标显著改善,短期预后与non-LN患者相似。
Objective To study and analyze the differences in clinical characteristics,treatment plans,and short-term outcomes between patients with lupus nephritis and non-LN patients among first-time systemic lupus erythematosus patients in a real-world setting.Methods A retrospective analysis of 249 first-time SLE patient cases diagnosed at the Department of Rheumatology and Immunology,First Affiliated Hospital of Bengbu Medical University from January 2018 to January 2023.Patients were divided into the LN group(79 cases)and the non-LN group(170 cases)based on whether they had kidney involvement at the time of SLE diagnosis.The clinical features,treatment,and follow-up of both groups were compared.Results At the time of diagnosis,31.7%(79 cases)of the 249 first-time SLE patients developed LN.There were no statistically significant differences between the LN group and the non-LN group in terms of female proportion,age at onset,age at diagnosis,and disease duration(all P>0.05).However,patients in the LN group had lower levels of hemoglobin,platelet count,serum albumin,complement C3,and complement C4 compared to those in the non-LN group(all P<0.05).The incidence of arthritis was lower in the LN group than in the non-LN group,while the incidence of infection,pleurisy,and pericarditis was higher in the LN group than in the non-LN group(all P<0.05).The positive rates of anti-dsDNA antibodies and anti-SSB antibodies were higher in the LN group than in the non-LN group(all P<0.05).The SLEDAI-2000 score of LN group was higher than that of non-LN group(13.2 vs.7.4,P<0.001),but the non-kidney SLEDAI-2000 score was lower than that of non-LN group(5.7 vs.7.4,P=0.007).The proportion of patients with severe SLEDAI-2000 score was higher than that of non-LN group,and the proportion of patients with mild SLEDAI-2000 score was lower than that of non-LN group(60.8%vs.12.9%,13.9%vs.55.3%,all P<0.001).In the induction therapy,54 patients(80.6%)in the LN group and 80 patients(56.7%)in the non-LN group received immunosuppressive therapy,including biologics(80.6%vs.56.7%,P<0.001).The incidence of adverse events related to infection was higher in the LN group than in the non-LN group within 12 months of treatment(28.4%vs.16.3%,P=0.043).During the follow-up period,the overall renal remission rate was higher in the LN group at 12 months compared to 6 months.At 12 months,43 patients(64.2%)achieved complete renal response,22 patients(32.8%)had partial renal response,and 2 patients(3.0%)showed no renal response.Their hemoglobin,platelet count,serum albumin,complement C3,and complement C4 levels improved significantly compared to before treatment(all P<0.001).There were no statistically significant differences between the two groups in terms of mortality,tumor-related complications,and other follow-up outcomes(all P>0.05).The proportion and time to achieving a low disease activity state or remission in both groups were not statistically significant,and there were no significant differences in the proportion and time of lupus disease activity recurrence(all P>0.05).Conclusion In patients with primary SLE,LN patients showed higher incidence of pericarditis,pleurisy,and infections,as well as higher positivity rates for Anti-dsDNA and Anti-SSB.Conversely,they exhibited lower activity of extrarenal diseases,lower incidence of arthritis,and lower serum albumin levels.After 12 months of induction therapy,LN patients demonstrated significantly improved overall renal response and related laboratory parameters,with short-term prognosis comparable to non-LN patients.
作者
李宁
陈松岳
武倩
宫牧雪
洪登校
范晓云
王涛
梅永君
谢长好
LI Ning;CHEN Song-yue;WU Qian;GONG Mu-xue;HONG Deng-xiao;FAN Xiao-yun;WANG Tao;MEI Yong-jun;XIE Chang-hao(Department of Rheumatology and Immunology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,Anhui,China)
出处
《广东医学》
2025年第11期1650-1659,共10页
Guangdong Medical Journal
基金
安徽省自然科学基金资助项目(2108085MH258)。
关键词
狼疮性肾炎
系统性红斑狼疮
临床特点
治疗
随访
lupus nephritis
systemic lupus erythematosus
clinical features
treatment
follow-up
