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狼疮性肾炎患者免疫抑制剂治疗无效的影响因素
Influencing factors for immunosuppressant therapy ineffectiveness in patients with lupus nephritis

内科 202419卷04期 页码:417-422

作者机构:河南省平顶山市第一人民医院肾脏病风湿免疫科,平顶山市 467000

DOI:10.16121/j.cnki.cn45⁃1347/r.2024.04.13

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  • 英文简介
  • 参考文献

目的 探讨狼疮性肾炎(LN)患者免疫抑制剂治疗无效的影响因素。方法 回顾性分析接受免疫抑制剂治疗的116例LN患者的临床资料,根据治疗效果将未达到缓解、肾脏死亡和临床死亡的LN患者归为无效组(n=26),完全缓解和部分缓解的LN患者归为有效组(n=90)。比较两组一般资料、实验室指标、病理特征指标,并应用多因素Logistic回归模型分析LN患者免疫抑制剂治疗无效的影响因素。结果 无效组肾损害病程、血清肌酐水平、甘油三酯水平、尿蛋白水平、尿酸水平、病理类型为Ⅲ~Ⅴ级者占比、间质慢性病变为中度和重度者占比、慢性指数、有球性硬化者占比、有血尿者占比均长/高于有效组,尿量和CD3+细胞、CD4+细胞、CD8+细胞水平均低于有效组(均P<0.05)。多因素Logistic回归模型分析结果显示,肾损害病程长、血清肌酐水平高、血尿、尿蛋白水平高、病理类型为Ⅲ~Ⅴ级均是LN患者免疫抑制剂治疗无效的危险因素(均P<0.05)。结论 肾损害病程长、血清肌酐高水平、血尿、尿蛋白水平高、病理类型为Ⅲ~Ⅴ级均是LN患者免疫抑制剂治疗无效的危险因素,对以上因素进行针对性干预或可提高免疫抑制剂治疗的临床效果。

Objective To investigate influencing factors for immunosuppressant therapy ineffectiveness in patients with lupus nephritis (LN). Methods The clinical data of 116 LN patients treated with immunosuppressants were retrospectively analyzed, and according to the therapeutic effects, the LN patients who did not achieve remission, with renal failure, or of clinical death were classified as the ineffective group (n=26), and LN patients with complete remission or partial remission were classified as the effective group (n=90). The general data, laboratory indexes, and pathological characteristics indexes of the two groups were compared, and the multivariate logistic regression model was used to analyze the influencing factors for immunosuppressant therapy ineffectiveness in LN patients. Results The renal damage course, serum creatinine level, triglyceride level, urine protein level, uric acid level, proportion of patients with grade Ⅲ-Ⅴ pathological type, proportion of patients with moderate and severe chronic lesions in renal interstitium, chronic index, proportion of patients with glomerulosclerosis, and proportion of patients with hematuria were longer/higher than those in the effective group, while the urine output and levels of CD3+ cells, CD4+ cells, and CD8+ cells were lower in the ineffective group than in the effective group (all P<0.05). The results of multivariate logistic regression model analysis showed that a long renal damage course, a high serum creatinine level, hematuria, a high urine protein level, and grade Ⅲ-Ⅴ pathological type were risk factors for immunosuppressant therapy ineffectiveness in LN patients (all P<0.05). Conclusion A long renal damage course, a high serum creatinine level, hematuria, a high urine protein level, and grade Ⅲ-Ⅴ pathological type are risk factors for immunosuppressant therapy ineffectiveness in LN patients, and targeted intervention on the abovementioned factors may improve the clinical effect of immunosuppressant therapy.

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