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目的:分析狼疮性肾炎(LN)患者的临床特征和肾脏远期预后,并对影响肾脏预后的危险因素进行评估。方法:收集本中心经肾活检明确诊断为LN,随访时间≥1年汉族患者的资料,观察终点为进入终末期肾病(ESRD)。结果:本研究共纳入患者1 814例,其中男性253例(13.9%),女性1 561例(86.1%);肾脏病理改变为Ⅱ型患者127例(7.0%)、Ⅲ型244例(13.5%)、Ⅲ+Ⅴ型202例(11.1%)、Ⅳ型711例(39.2%)、Ⅳ+Ⅴ型284例(15.7%)和Ⅴ型246例(13.6%);LN患者5年、10年、15年、20年和25年肾脏生存率分别为93.1%、87.9%、81.0%、68.3%和58.7%;患者的性别、LN病程、平均动脉压、尿蛋白定量、血清肌酐、血红蛋白、血清补体水平及病理类型是ESRD的独立危险因素。随访指标时间平均尿蛋白和时间平均平均动脉压均为ESRD的独立危险因素,且其预测价值分别高于基线尿蛋白和平均动脉压。结论:结果显示中国汉族LN患者远期预后良好。肾脏预后和病理类型相关,Ⅳ型和Ⅳ+Ⅴ型LN患者肾脏预后最差。病程中应积极控制尿蛋白和血压以减少ESRD的发生。
Objective: To analyze the clinical characteristics and renal long-term prognosis of patients with lupus nephritis (LN) and to evaluate the risk factors that affect the prognosis of kidney. Methods: The data of Han patients diagnosed as LN by renal biopsy and the follow-up time> 1 year were collected. The end point was end-stage renal disease (ESRD). RESULTS: A total of 1 814 patients were enrolled in this study, including 253 males (13.9%) and 1 561 females (86.1%), 127 (7.0%) with pathological changes of type II and 244 (13.5% ), 202 (11.1%) in type Ⅲ + Ⅴ, 711 (39.2%) in type Ⅳ, 284 (15.7%) in type Ⅳ + Ⅴ and 246 (Ⅴ) The renal survival rates at 15 years, 20 years and 25 years were 93.1%, 87.9%, 81.0%, 68.3% and 58.7% respectively. The gender, LN duration, mean arterial pressure, urinary protein, serum creatinine, hemoglobin, serum complement The level and pathological type are independent risk factors for ESRD. Follow-up index urinary protein and time mean mean arterial pressure were independent risk factors for ESRD, and its predictive value were higher than the baseline urinary protein and mean arterial pressure. Conclusion: The results show that long-term prognosis of LN patients in Chinese Han is good. Renal prognosis and pathological type related to type IV and â ... ¢ type â ... ¤ LN patients with the worst prognosis of kidney. Urinary protein and blood pressure should be actively controlled in order to reduce the occurrence of ESRD.