抗磷脂抗體是否為紅斑性狼瘡腎炎的預後因子

Is antiphospholipid antibody related to outcome of lupus nephritis? – A 2-year analysis

目的：研究抗磷脂抗體對紅斑性狼瘡腎炎的腎功能預後的影響。方法：本研究回溯性調閱本院過去經診斷為紅斑性狼瘡腎炎病人之病歷，他們都符合美國風濕病醫學會紅斑性狼瘡分類標準，並於1986-2007期間在本院接受過腎臟切片，經確認為狼瘡性腎炎。但我們只收集有驗過至少一項抗磷脂抗體試驗的病患之人口統計學，血清學資料及治療內容。主要觀察重點為24個月內達到兩倍血中肌酸酐或末期腎病變／死亡的比率。結果：我們總共收錄66病患，其中包括55個女性及11個男性。平均年齡30.53 ± 11.09歲。18位病患抗磷脂抗體陽性（27.3%）（I），餘下48位病患為陰性（72.7%）（II）。在2年的存活分析發現抗磷脂抗體陽性的病患（I）有較好的腎臟預後（p<0.05）。結論：與之前的研究相反的是抗磷脂抗體陽性在我們狼瘡腎炎的病患可能有較好的腎臟預後。

Objective: To investigate the impact of antiphospholipid antibodies (aPLA) on renal outcome in lupus nephritis (LN). Materials and Methods: A retrospective chart review study of patients with biopsy-proven LN was conducted between 1986 and 2007 at Chang Gung Memorial Hospital in Kaohsiung. All of the patients fulfilled the systemic lupus erythematosus classification criteria of the American College of Rheumatology and had histopathological findings compatible with LN. Only those patients whose aPLA, including anti-cardiolipin antibody, anti-β2GPI antibody, Venereal Disease Research Laboratory test, and lupus anticoagulant had been checked were recruited. We reviewed the charts and collected the demographics, clinical characteristics, serological parameters, and treatment courses of the patients recruited. The renal outcome end point was either end-stage renal disease or doubling of serum creatinine within 24 months Results: A total of 66 subjects were recruited, including 55 females and 11 males. The mean age was 30.5± 11.1 years. aPLA was present in 18 patients (27.3%) (group I), and 48 patients (72.7%) (group II) had negative test results. The seropositive ratios of anti-dsDNA and anti-RNP in group I were significantly higher (p=0.023 and 0.026) than in group II, respectively. There was no statistical difference in other parameters between the groups. The subjects in group I had a more favorable (p=0.038) renal outcome after 2 years of follow-up. Conclusions: Contradictory to previous studies, the presence of aPLA in patients with LN is probably associated with a better renal outcome.