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目的探讨在成功的泼尼松和环磷酰胺诱导治疗后,引起弥漫增生型(Ⅳ型)狼疮肾炎复发的预测指标。方法收集弥漫增生型狼疮肾炎病例,将泼尼松和环磷酰胺诱导治疗成功的病例纳入研究对象。记录临床和实验室资料,于治疗开始后6个月时检测患者尿巨噬细胞趋化蛋白(MCP)-1和巨噬细胞集落刺激因子(M-CSF)。追踪治疗后的复发情况。结果共收集到64例诱导治疗成功的病例,经平均(27±3)个月随访,18例(28%)患者发生至少一次肾性复发,其复发的平均时间为(14±4)个月。复发组患者尿MCP-1和M-CSF水平明显高于缓解维持组。尿MCP-1和M-CSF升高,及血C3降低和抗dsDNA抗体阳性均是Ⅳ型狼疮肾炎复发的独立预测因子。有7例患者出现血肌酐倍增(CRX2),肾性复发是CRX2的惟一预测因子。结论尿MCP-1和M-CSF持续升高是Ⅳ型狼疮肾炎复发的独立预测因子。该研究提示监测诱导缓解患者肾组织炎症指标可有利于指导狼疮肾炎的治疗。
Objective To investigate the predictive value of relapse of diffuse proliferative (Ⅳ) lupus nephritis after the successful induction of prednisone and cyclophosphamide. Methods The patients with diffuse proliferative lupus nephritis were collected and the cases of successful induction of prednisone and cyclophosphamide were included in the study. Clinical and laboratory data were recorded and urinary macrophage chemotactic protein (MCP) -1 and macrophage colony stimulating factor (M-CSF) were tested at 6 months after initiation of treatment. Follow up the recurrence after treatment. Results A total of 64 cases of successful induction therapy were collected. At an average of (27 ± 3) months follow-up, 18 (28%) patients had at least one renal recurrence with an average recurrence of (14 ± 4) months . Urinary MCP-1 and M-CSF levels in patients with recurrent disease were significantly higher than those in relapse maintenance group. Increased urinary MCP-1 and M-CSF, and decreased blood C3 and anti-dsDNA antibody were all independent predictors of relapse in type IV lupus nephritis. Seven patients had serum creatinine doubling (CRX2) and renal recurrence was the only predictor of CRX2. Conclusions The persistent increase of urinary MCP-1 and M-CSF is an independent predictor of the relapse of type IV lupus nephritis. This study suggests that monitoring the indicators of renal tissue inflammation in patients with remission may be helpful to guide the treatment of lupus nephritis.