摘要目的 分析系统性红斑狼疮(SLE)狼疮肾炎患者的临床特点及预后因素.方法 收集1999至2012年江苏省15所医院共2 078例SLE患者首次住院临床资料,将其分为狼疮肾炎组与非狼疮肾炎组,差异统计学意义比较采用秩和U检验、x2检验,应用Cox回归分析影响预后的相关因素.结果 (1)狼疮肾炎组883例(42.5％),其平均发病年龄明显低于非狼疮肾炎组[(30±11)岁比(32±12)岁,P＜0.01].(2)狼疮肾炎组心肺受累、神经精神受累、胃肠受累、血液受累、眼部受累、入院时SLEDAI评分＞9分及出院时SLEDAI评分＞9分的发生率明显高于非狼疮肾炎组(31.5％、7.9％、13.9％、69.0％、1.5％、77.4％及29.8％比18.8％、5.1％、6.8％、63.1％、0.3％、43.1％及8.1％,均P＜0.01).(3)狼疮肾炎组首次住院后1、5年死亡率明显高于非狼疮肾炎组(7.2％、15.0％比3.1％、6.3％,均P＜0.01).(4)狼疮肾炎组患者死亡的危险因素是神经精神受累(HR 2.46)、出院时SLEDAI评分＞9分(HR2.34)、血肌酐升高(HR2.21)及丙氨酸转氨酶和(或)天冬氨酸转氨酶升高(HR2.09),保护因素是糖皮质激素治疗(HR0.18).结论 狼疮肾炎是年轻早期SLE患者的常见并发症,且易同时并发其他重要器官受累,病情活动度高、治疗困难,尤其在神经精神受累、血肌酐升高或转氨酶升高时预后更差,糖皮质激素治疗有助于改善狼疮肾炎预后.

abstractsObjective To explore the clinical features and prognosis of patients with lupus nephritis (LN) in a large multicenter lupus cohort of Jiangsu Province.Methods Medical records of 2 078 systemic lupus erythematosus (SLE) inpatients from 15 hospitals at the first admission from 1999 to 2012 were reviewed and classified into two groups with LN or without.The clinical features between two groups were compared with Mann-Whitney U or Chi-square test and potentially associated factors tested by Cox regression.Results A total of 883 (42.5％) hospitalized lupus patients were diagnosed as LN.And the median age at disease onset of LN patients was lower than that of those without LN [(30 ± 11) vs (32 ± 12) years,P ＜ 0.01].Cardiopulmonary involvement,neuropsychiatric disorder,gastrointestinal dysfunction,hematologic disease,ophthalmopathy,SLEDAI score ＞ 9 at admission and SLE disease activity index (SLEDAI) score ＞ 9 at discharge were more often seen in patients with LN compared to those without LN (31.5％,7.9％,13.9％,69.0％,1.5％,77.4％,29.8％ vs 18.8％,5.1％,6.8％,63.1％,0.3％,43.1％,8.1％,all P ＜0.01).The mortality rates at 1 or 5 years after first admission were both significantly higher in LN patients than those without LN (7.2％,15.0％ vs 3.1％,6.3％,P ＜0.01).Independent predictors for mortality in patients with LN were neuropsychiatric involvement [hazard ratio (HR) 2.46],SLEDAI score ＞ 9 at discharge (HR 2.34),increased serum creatinine (HR 2.21) and elevated alanine aminotransferase and (or) aspartate transaminase (HR 2.09) whereas glucocorticosteroid therapy (HR 0.18) was a protective factor.Conclusion LN is one common complication of SLE patients during an early stage.And LN patients are more prone to present other vital organ involvement,higher disease activity and worse treatment outcomes.When accompanied with neuropsychiatric involvement,increased serum creatinine or elevated transaminase,worse prognosis is expected.Glucocorticosteroid treatment may offer some benefits.