论文部分内容阅读
目的 研究狼疮肾炎 (LN)患者的临床、实验室及肾穿病理参数对患者生存率 (SR)和肾脏生存率 (RSR)的影响。方法 对 73例作肾活检的LN患者进行随访 ,按WHO关于LN的病理分型进行分类。用Kaplan Maier方法计算SR和RSR。用Cox比例风险模型分析各临床和实验室变量对SR和RSR影响的风险程度。用多变量逐步回归法分析肾穿病理参数对SR和RSR的独立预测价值。结果 73例LN患者 5年的SR和RSR分别为 95 3%和 83 3% ,10年为 78 8%和 6 5 3%。不同病理组间患者SR和RSR的差异无显著性。多变量回归分析表明是否得到早期诊断和血清肌酐水平对SR和RSR均有明显的影响 ,而 2 4h尿蛋白定量水平对RSR的影响明显。肾活检病理参数中 ,RSR的下降与肾脏的慢性病理改变如肾小管的萎缩、肾间质的纤维化、CI >3以及肾小动脉的损伤均明显相关 ,而肾小管的萎缩还与SR的降低显著相关。结论 早期诊断对延长LN的SR和RSR起重要作用。临床上血清肌酐和 2 4h尿蛋白定量的水平是影响预后的最重要指标。病理上肾脏的慢性病理改变及肾动脉的损伤是影响生存率的独立危险因素
Objective To investigate the influence of clinical, laboratory and renal pathological parameters on survival rate (SR) and renal survival rate (RSR) in patients with lupus nephritis (LN). Methods Totally 73 LN patients undergoing renal biopsy were followed up and classified according to WHO’s pathological classification of LN. SR and RSR were calculated using the Kaplan-Maier method. Cox proportional hazards model was used to analyze the risk of each clinical and laboratory variable affecting SR and RSR. Multivariate stepwise regression analysis was used to analyze the independent predictive value of pathological parameters of renal on SR and RSR. Results The 5-year SR and RSR of 73 patients with LN were 95.3% and 83.3% respectively, 78.8% and 65.3% respectively in 10 years. There was no significant difference in SR and RSR between different pathology groups. Multivariable regression analysis showed that whether early diagnosis and serum creatinine level had significant effects on SR and RSR, while the 24 h urinary protein level had a significant effect on RSR. Renal biopsy pathological parameters, the decline of RSR and chronic renal pathological changes such as tubular atrophy, interstitial fibrosis, CI> 3 and renal arterioles were significantly related to injury, and renal tubular atrophy with SR Reduce the significant correlation. Conclusion Early diagnosis plays an important role in prolonging SR and RSR of LN. Clinically serum creatinine and 24 h proteinuria level is the most important prognostic indicators. Chronic pathological renal pathology and renal artery injury is an independent risk factor affecting the survival rate