摘要 15 - 狼疮的低疾病活动状态:一个未被充分利用的临床目标,可实现并防止狼疮肾炎复发

C. Cheung, Chak Sing Lau, S. C. Chan
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引用次数: 0

摘要

背景 狼疮性肾炎(LN)是一种严重的合并症,约有 50-60% 的系统性红斑狼疮(SLE)患者会受到影响。完全和部分肾脏反应(CRR/PRR)已被推荐为 LN 的治疗目标。狼疮低疾病活动状态(LLDAS)也与有利的临床结果有关。本研究旨在调查 LN 患者的 LLDAS 达标率和疗效。方法 纳入玛丽医院 2010-2020 年期间经活检证实的 LN 患者。记录基线人口统计学、血液参数和尿液分析结果。在确诊 LN 后 12 个月评估肾脏反应和 LLDAS 达标情况。CRR定义为蛋白尿[计算公式:见正文]0.5克/天,估计肾小球滤过率(eGFR)正常;PRR定义为蛋白尿减少[计算公式:见正文]50%,eGFR接近正常。复发的定义是在初始治疗反应蛋白尿减少[公式:见正文]50%或降至肾病范围以下后,组织学活检证实有活动性LN。为比较CRR/PRR和LLDAS达标的意义,进行了复发时间生存分析。结果 共纳入 143 名 LN 患者,中位随访时间为 10.4 年。在 12 个月时,分别有 57(40%)、14(10%)和 69(48%)名患者达到了 CRR、PRR 和 LLDAS。虽然有 39 例(27%)患者同时达到了 CRR/PRR 和 LLDAS,但仍有 30 例(21%)患者在未达到 CRR/PRR 的情况下达到了 LLDAS(图 1)。在达到预设治疗反应的 136 例患者中,有 30 例(22%)患者在中位 2.98 年后出现 LN 复发。达到 CRR/PRR 或 LLDAS 的患者复发风险显著降低(CRR/PRR:HR = 0.34,p = 0.02;LLDAS:HR = 0.28,p = 0.003)。同时达到 CRR/PRR 和 LLDAS 的患者复发风险最低(图 2)。结论 我们提倡将 LLDAS 作为 LN 患者的目标,因为达到 LLDAS 可降低 LN 未来的复发风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Abstract 15 — Lupus Low Disease Activity State: An Underutilised Clinical Target that is Attainable and Protective against Lupus Nephritis Relapse
Background Lupus nephritis (LN) is a significant comorbidity affecting approximately 50-60% of patients with systemic lupus erythematosus (SLE). Complete and partial renal response (CRR/PRR) have been recommended as treatment targets in LN. Lupus low disease activity state (LLDAS) is also associated with favourable clinical outcomes. This study aims to investigate the LLDAS attainment rate and outcomes in patients with LN. Methods Patients with biopsy-proven LN during 2010-2020 in Queen Mary Hospital were included. Baseline demographics, blood parameters and urinalysis results were documented. Renal response and LLDAS attainment were assessed at 12 months after LN diagnosis. CRR was defined as proteinuria [Formula: see text]0.5g/day with a normal estimated glomerular filtration rate (eGFR); PRR was defined as a reduction in proteinuria by [Formula: see text]50% with near normal eGFR. A relapse was defined as a biopsy-proven active LN on histology after an initial treatment response of proteinuria reduction of [Formula: see text]50% or to sub-nephrotic range. Time-to-relapse survival analysis was performed to compare the significance of CRR/PRR and LLDAS attainment. Results 143 LN patients were included, with a median follow-up duration of 10.4 years. At 12 months, 57 (40%), 14 (10%) and 69 (48%) patients achieved CRR, PRR and LLDAS, respectively. Although 39 (27%) patients attained both CRR/PRR and LLDAS, a significant number of 30 (21%) patients reached LLDAS without meeting CRR/PRR (Figure 1). Among 136 patients who achieved the pre-defined treatment response, 30 (22%) patients developed LN relapse after a median of 2.98 years. Patients reaching either CRR/PRR or LLDAS had a significantly lower risk of relapse (CRR/PRR: HR = 0.34, p = 0.02; LLDAS: HR = 0.28, p = 0.003). The attainment of both CRR/PRR and LLDAS was associated with the lowest risk of relapse (Figure 2). Conclusion We advocate LLDAS as a target for LN patients as attaining LLDAS reduces future LN relapse risks.
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