狼瘡腎炎惡化危險因子分析──台灣單一醫學中心研究

Predictors of renal outcome in patients with lupus nephritis: A single center experience in Taiwan

Objective: To evaluate the clinical and laboratory profile of patients with lupus nephritis (LN) and the riskfactors for renal progression in a single center at Taiwan.Methods: Patients with biopsy-proven LN were included. Clinical and laboratory patterns were comparedbetween patients with renal progression and those without. Univariate and multivariate risk factor analysesfor poor renal outcome were also performed.Results: The mean age of the 158 patients (142 women, 89.3%) with LN was 36.6 years. Hypertension,high creatinine level, daily urine protein, and chronicity index differed significantly between the renalprogression and non-progression groups. The most common pathological patterns of LN were classes III(18.2%), IV (59.7%), and V (17.6%). Multivariate analysis showed that creatinine level (HR: 2.2, 95% CI:1.28-3.93, p=0.005), daily urine protein (HR: 1.1, 95% CI: 1.05-1.24, p=0.002), and chronicity index (HR:1.2, 95% CI: 1.02-1.42, p=0.030) were risk factors for renal progression in patients with LN.Conclusions: Daily urine protein, chronicity index, and creatinine level can predict poor renal outcome inpatients with LN. 目的：利用狼瘡腎炎病人臨床表現與實驗室數據來評估腎臟預後。方法：腎臟切片確診的狼瘡腎炎的病人納入收案，將病人被分成兩組，一組腎功能惡化，一組腎功能無惡化，並比較臨床與實驗數值的差別。最後利用單變項與多變項危險因子來檢視造成腎炎惡化的危險因子。結果：總計158位狼瘡腎炎病人被收案，平均年齡為36.6歲，其中142位為女性（89.3%）。比較狼瘡腎炎惡化與無惡化兩組之間的差異，發現高血壓、較高的血中肌酸酐數值和較高的每日尿蛋白數值在腎功能惡化組別顯著較高。狼瘡腎炎分級常見的分級為第三型（18.2%），第四型（59.7%）與第五型（17.6%）。多變項危險因子分析顯示肌酸酐（HR 2.2, 95% CI 1.28-3.93, P＝0.005），每日蛋白尿（HR 1.1, 95% CI 1.05-1.24, P＝0.002）和狼瘡切片慢性指數（HR 1.2, 95% CI 1.02-1.42,P＝0.030）可以預測狼瘡腎炎腎功能惡化。結論：血中肌酸酐、每日蛋白尿與腎臟切片的慢性指數為狼瘡腎炎病人腎功能惡化的預後指標。