全身紅斑性狼瘡病患進展至末期腎病的危險因子：單一醫學中心的回溯性世代研究

Risk Factors for Progression to End-Stage Renal Disease among Systemic Lupus Erythematosus Patients: A Medical Center Retrospective Cohort Study

目的：探討全身紅斑性狼瘡病患進展至末期腎病的危險因子，並分析狼瘡腎炎病患的腎臟切片病理分類。方法：回溯性調查689位2005-2012年住院的全身紅斑性狼瘡病患，自住院日開始追蹤，至發生末期腎病、死亡、失去追蹤、或2019年為止。其中23位病患被排除，包括22位住院前就已是末期腎病狀態，以及1位缺少初始血清肌酸酐值。本研究使用Cox proportional hazard model來分析全身紅斑性狼瘡病患的末期腎病危險因子。結果：總共666位病患被納入研究，其中46（6.9%）位病患進展至末期腎病，Cox proportional hazard model的多變數分析顯示，顯著上升末期腎病風險的危險因子包括蛋白尿（HR 13.54，95% CI 1.81-101.09，p=0.011）、高肌酸酐（每增加1 mg/dL，HR 1.65，95% CI 1.31-2.07，p<0.001）、癲癇（HR 2.84，95% CI 1.48-5.45，p=0.002）、以及高血壓（HR 3.50，95% CI 1.71-7.15，p=0.001）。而在666位病患中，有72位接受腎臟切片，其中的51（70.8%）位的腎臟切片病理分類是第IV類。結論：本研究顯示全身紅斑性狼瘡病患進展至末期腎病的獨立危險因子包括蛋白尿、氮血症、高血壓、以及癲癇，其中癲癇較少在之前的研究被提及。

Objectives: This study aimed to determine the risk factors for progression to end-stage renal disease (ESRD) in systemic lupus erythematosus (SLE) patients and to analyze the distributions of renal pathological classifications in lupus nephritis patients.Methods: We retrospectively evaluated the medical records of 689 SLE patients who were admitted during 2005-2012. The follow-up duration was from admission to ESRD, death, loss of follow-up, or 2019. Twenty-three patients were excluded due to a diagnosis of ESRD before admission (n=22) or no initial serum creatinine data (n=1). The Cox proportional hazard model was performed to determine the risk factors for ESRD in SLE patients.Results: A total of 666 SLE patients were included in the study, and 46 (6.9%) patients developed ESRD. The multivariate Cox proportional hazard model demonstrated a significant increase in the hazard ratio (HR) of ESRD in SLE patients with proteinuria (HR 13.54, 95% CI 1.81-101.09, p=0.011), elevated creatinine levels (for every 1 mg/dL increase, HR 1.65, 95% CI 1.31-2.07, p<0.001), seizure (HR 2.84, 95% CI 1.48-5.45, p=0.002), and hypertension (HR 3.50, 95% CI 1.71¬7.15, p=0.001). Among the 666 patients included in the study, 72 of these patients had received a renal biopsy. The biopsy results showed 51 (70.8%) of the 72 patients were class IV with regard to the classification of glomerulonephritis in SLE. Conclusions: We reported the independent potential risk factors for progression to ESRD among SLE patients, including proteinuria, azotemia, hypertension, and seizure. Seizure has seldom been mentioned as a risk factor in previous studies.