紅斑性狼瘡腎炎的預後－－五年分析報告

Outcome of lupus nephritis – A 5-year analysis

目的：調查第四期紅斑性狼瘡腎炎的長期預後並分析影響預後因子。方法：本研究回溯性調閱本院157位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1986-2004期間在本院接受過腎臟切片，經確認為狼瘡性腎炎。但我們只收集符合2003 ISN/RPS 第四期紅斑性狼瘡腎炎病患之人口統計學，血清學資料及治療內容。主要觀察重點為60個月內達到兩倍血中肌酸酐（Cr）（I）及末期腎病變（ESRD）／死亡（II）的比率。結果：我們總共收錄75位符合2003 ISN/RPS 第四期紅斑性狼瘡腎炎病患之資料，其中包含13位男生，62位女生。平均年齡25.9 ± 9.7歲。五年後16人（21.3%）達到觀察重點（I），15人（20%）達到觀察重點（II）。其中沒有發展成兩倍Cr者比達到兩倍Cr者，有較高（14.5 ± 2.1）活動指數（activity index，AI）（HR = 0.552，CI = 0.351-0.870，p=0.01）。沒有發展成ESRD/death者比達到者的AI為14.4 ± 2.2 vs. 13.5 ± 2.3（HR = 0.666，CI = 0.443-1.000，p=0.05）。結論：第四期紅斑性狼瘡腎炎在末期腎病變／死亡方面達到五年長期存活預後的比率為80%，略低於其他的調查。另外腎臟切片時有較高的AI 是好的腎臟預後因子。

Objective: To investigate the long-term outcome of class IV lupus nephritis (LN) and to analyze its prognostic factors. Materials and Methods: We performed a retrospective chart review study of 157 patients with LN between January 1986 and June 2004 in Chang Gung Memorial Hospital at Kaohsiung. All of these LN patients fulfilled the systemic lupus erythematosus classification criteria of the American College of Rheumatology and had histopathological findings of LN. Only those pathology-proved subjects with class IV by 2003 ISN/RPS classification were recruited. We reviewed the charts and collected the demographic data, serological parameters, and treatment courses of subjects recruited. The end point of renal outcome were doubling of serum creatinine (I) and end stage renal disease (ESRD)/death (II) within 60 months after renal biopsy Results: A total of 75 subjects were recruited, including 13 male and 62 female. Mean age was 25.9 ± 9.7 year. Five years after renal biopsy, 16 subjects (21.3%) developed outcome I and 15 subjects (20.0%) developed outcome II. Those who did not develop outcome I had higher mean (14.5 ± 2.1) activity index (AI) than that (13.1 ± 2.5) of those did (HR = 0.55, CI = 0.35-0.87, p=0.01). For those who did not develop outcome II, the mean AI was also higher than those who did (14.4 ± 2.2 vs.13.5 ± 2.3, HR = 0.67, CI = 0.44-1.00, p=0.05). Conclusions: The 5-year renal survival of current series, in terms of ESRD/death, was 80% and this was not as favorable as those reported in the other investigations. High activity index at biopsy is a predictor of favorable prognosis of long-term renal outcomes in case that aggressive treatment had been given.