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目的:分析激素联合吗替麦考酚酯(MMF)治疗增殖性狼疮性肾炎(LN)的疗效及远期预后。方法:经肾活检病理诊断为Ⅲ型、Ⅳ型及Ⅲ/Ⅳ+Ⅴ型LN并接受激素和MMF诱导治疗≥3个月的235例患者纳入本研究。根据MMF维持治疗疗程不同分为MMF长期维持组(组Ⅰ)、MMF短期维持组(组Ⅱ)、非MMF维持组(组Ⅲ)。诱导治疗疗效分为完全缓解、部分缓解和未缓解。复合肾脏终点事件包括终末期肾病(ESRD)、肌酐倍增和估算的肾小球滤过率(e GFR)下降≥50%。结果:221例(94.0%)患者获得缓解,6个月和9个月的总缓解率分别为89.3%和90.2%,完全缓解分别为47.6%和53.1%,不同病理类型的缓解率无统计学差异(P>0.05)。中位随访时间83个月。随访期间,共73例(33.0%)复发,组Ⅰ复发率(22.1%)显著低于组Ⅱ(45.5%,P<0.05)和组Ⅲ(44.4%,P<0.05)。多因素COX回归分析发现组Ⅱ(HR 2.29,95%CI 1.18~4.47,P=0.015)和组Ⅲ(HR 3.22,95%CI 1.85~5.61,P<0.001)的复发风险显著高于组Ⅰ。10年复合肾脏终点事件发生率组Ⅰ(4.8%)低于组Ⅱ(10.6%)和组Ⅲ(13.9%),但无统计学差异(P>0.05)。结论:MMF诱导缓解后长期MMF维持能获得较好的持续缓解率,长期MMF维持可降低复发率和终点事件发生率。
Objective: To evaluate the efficacy and long-term prognosis of hormone combined with mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis (LN). Methods: A total of 235 patients with type Ⅲ, Ⅳ and Ⅲ / Ⅳ + Ⅴ LN diagnosed by renal biopsy and treated with hormone and MMF for ≥3 months were enrolled in this study. MMF was divided into long-term maintenance group (group Ⅰ), MMF short-term maintenance group (group Ⅱ) and non-MMF maintenance group (group Ⅲ) according to the different course of MMF maintenance treatment. Induction therapy was divided into complete remission, partial remission and no remission. Complex renal endpoints include end-stage renal disease (ESRD), creatinine doubling, and a ≥ 50% reduction in estimated glomerular filtration rate (e GFR). Results: 221 patients (94.0%) were relieved. The total remission rates at 6 months and 9 months were 89.3% and 90.2%, respectively, with complete remission of 47.6% and 53.1% respectively. There was no statistical difference in the rates of different pathological types Difference (P> 0.05). The median follow-up time was 83 months. During follow-up, a total of 73 patients (33.0%) relapsed. The recurrence rate of group Ⅰ (22.1%) was significantly lower than that of group Ⅱ (45.5%, P <0.05) and group Ⅲ (44.4%, P <0.05). Multivariate Cox regression analysis found that the risk of recurrence in group Ⅱ (HR 2.29, 95% CI 1.18-4.47, P = 0.015) and group Ⅲ (HR 3.22, 95% CI 1.85-5.61, P <0.001) was significantly higher than that in group Ⅰ. The incidence of composite renal end point event in 10 years was lower than that in group Ⅱ (10.6%) and group Ⅲ (13.9%), but there was no significant difference (P> 0.05). CONCLUSION: Long-term MMF maintenance can achieve a good sustained remission rate after MMF-induced remission, and long-term MMF maintenance can reduce the recurrence rate and the incidence of end-point events.