Xinxin Zhang, Manhuai Zhang, Xiaolei Shi, Wang Xiang, Yuewen Lu, Jiaqing Tan, Jianwen Yu, Hongjian Ye, Zhong Zhong, Jiang Lanping, Ruihan Tang, Xi Xia, Wei Chen
{"title":"总小管间质评分：一种简单有效的预测狼疮性肾炎长期死亡率和不良肾脏预后的指标。","authors":"Xinxin Zhang, Manhuai Zhang, Xiaolei Shi, Wang Xiang, Yuewen Lu, Jiaqing Tan, Jianwen Yu, Hongjian Ye, Zhong Zhong, Jiang Lanping, Ruihan Tang, Xi Xia, Wei Chen","doi":"10.1136/lupus-2025-001578","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Most studies focused on glomerular lesions in lupus nephritis (LN). However, the predictive value for tubulointerstitial lesions remains less well understood and controversial. Here, we assessed the impact of tubulointerstitial lesions, quantified by Total Tubulointerstitial Lesions Score (TTS), on long-term renal outcomes and mortality in LN.</p><p><strong>Methods: </strong>We conducted a cohort study of 832 patients with LN diagnosed from 1996 to 2018 at the First Affiliated Hospital of Sun Yat-sen University. Patients were stratified by the median of TTS (TTS ≤2 vs TTS >2 groups), which included the total score of tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis by the 2018 ISN/RPS (International Society of Nephrology and Renal Pathology Society) classification semi-score. We used Kaplan-Meier survival curves and Cox regression models to analyse the associations between TTS and patient outcomes.</p><p><strong>Results: </strong>Pearson's correlation analysis revealed that TTS was negatively correlated with estimated glomerular filtration rate, haemoglobin and serum albumin levels, while positively correlated with proteinuria levels. TTS was significantly higher in patients with proliferative LN. Kaplan-Meier analysis showed that patients with higher TTS had a higher risk of all-cause mortality and adverse renal outcomes. Multivariate Cox analysis identified TTS >2 (HR=1.50, 95% CI=1.02 to 2.22, p=0.039) and higher tubulointerstitial inflammation and tubular atrophy as the independent predictor of all-cause mortality, and TTS >2 (HR=1.63, 95% CI=1.05 to 2.52, p=0.030) and severer tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis were independently associated with adverse renal outcomes.</p><p><strong>Conclusions: </strong>TTS provides a comprehensive assessment of renal tubulointerstitial lesions and is a simple and effective predictor of long-term mortality and adverse renal outcomes in LN.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182180/pdf/","citationCount":"0","resultStr":"{\"title\":\"Total Tubulointerstitial Score: a simple and effective predictor of long-term mortality and adverse renal outcomes in lupus nephritis.\",\"authors\":\"Xinxin Zhang, Manhuai Zhang, Xiaolei Shi, Wang Xiang, Yuewen Lu, Jiaqing Tan, Jianwen Yu, Hongjian Ye, Zhong Zhong, Jiang Lanping, Ruihan Tang, Xi Xia, Wei Chen\",\"doi\":\"10.1136/lupus-2025-001578\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Most studies focused on glomerular lesions in lupus nephritis (LN). However, the predictive value for tubulointerstitial lesions remains less well understood and controversial. Here, we assessed the impact of tubulointerstitial lesions, quantified by Total Tubulointerstitial Lesions Score (TTS), on long-term renal outcomes and mortality in LN.</p><p><strong>Methods: </strong>We conducted a cohort study of 832 patients with LN diagnosed from 1996 to 2018 at the First Affiliated Hospital of Sun Yat-sen University. Patients were stratified by the median of TTS (TTS ≤2 vs TTS >2 groups), which included the total score of tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis by the 2018 ISN/RPS (International Society of Nephrology and Renal Pathology Society) classification semi-score. We used Kaplan-Meier survival curves and Cox regression models to analyse the associations between TTS and patient outcomes.</p><p><strong>Results: </strong>Pearson's correlation analysis revealed that TTS was negatively correlated with estimated glomerular filtration rate, haemoglobin and serum albumin levels, while positively correlated with proteinuria levels. TTS was significantly higher in patients with proliferative LN. Kaplan-Meier analysis showed that patients with higher TTS had a higher risk of all-cause mortality and adverse renal outcomes. Multivariate Cox analysis identified TTS >2 (HR=1.50, 95% CI=1.02 to 2.22, p=0.039) and higher tubulointerstitial inflammation and tubular atrophy as the independent predictor of all-cause mortality, and TTS >2 (HR=1.63, 95% CI=1.05 to 2.52, p=0.030) and severer tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis were independently associated with adverse renal outcomes.</p><p><strong>Conclusions: </strong>TTS provides a comprehensive assessment of renal tubulointerstitial lesions and is a simple and effective predictor of long-term mortality and adverse renal outcomes in LN.</p>\",\"PeriodicalId\":18126,\"journal\":{\"name\":\"Lupus Science & Medicine\",\"volume\":\"12 1\",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-06-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182180/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lupus Science & Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/lupus-2025-001578\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus Science & Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/lupus-2025-001578","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Total Tubulointerstitial Score: a simple and effective predictor of long-term mortality and adverse renal outcomes in lupus nephritis.
Objective: Most studies focused on glomerular lesions in lupus nephritis (LN). However, the predictive value for tubulointerstitial lesions remains less well understood and controversial. Here, we assessed the impact of tubulointerstitial lesions, quantified by Total Tubulointerstitial Lesions Score (TTS), on long-term renal outcomes and mortality in LN.
Methods: We conducted a cohort study of 832 patients with LN diagnosed from 1996 to 2018 at the First Affiliated Hospital of Sun Yat-sen University. Patients were stratified by the median of TTS (TTS ≤2 vs TTS >2 groups), which included the total score of tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis by the 2018 ISN/RPS (International Society of Nephrology and Renal Pathology Society) classification semi-score. We used Kaplan-Meier survival curves and Cox regression models to analyse the associations between TTS and patient outcomes.
Results: Pearson's correlation analysis revealed that TTS was negatively correlated with estimated glomerular filtration rate, haemoglobin and serum albumin levels, while positively correlated with proteinuria levels. TTS was significantly higher in patients with proliferative LN. Kaplan-Meier analysis showed that patients with higher TTS had a higher risk of all-cause mortality and adverse renal outcomes. Multivariate Cox analysis identified TTS >2 (HR=1.50, 95% CI=1.02 to 2.22, p=0.039) and higher tubulointerstitial inflammation and tubular atrophy as the independent predictor of all-cause mortality, and TTS >2 (HR=1.63, 95% CI=1.05 to 2.52, p=0.030) and severer tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis were independently associated with adverse renal outcomes.
Conclusions: TTS provides a comprehensive assessment of renal tubulointerstitial lesions and is a simple and effective predictor of long-term mortality and adverse renal outcomes in LN.
期刊介绍：
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.
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