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目的 探讨狼疮肾炎 (LN)肾功能不全病人与肾功能可逆性相关的因素。方法 采用回顾性队列研究策略 ,对 1991— 1999年住院的 173例LN肾功能不全患者进行 6个月的随访。结局因素 :氮质血症者血肌酐下降至 116 μmol/L以下 ,尿毒症者血肌酐下降 5 0 %以上 ,并脱离透析 3个月以上为阳性结局 ,死亡者因其肾功能不可能再恢复 ,因此删失时间为 2 8周。研究因素包括性别、年龄、病程、症状、并发症、狼疮活动指数、各种常规、生化和免疫学检查、药物治疗等 5 1个变量。统计学方法 :采用COX比例危险率回归模型分析。结果 142例 (82 1% )完成随访。 93例 (6 5 0 % )肾功能恢复 (阳性结局 ) ,17例 (12 0 % )死亡。在运用COX回归的多因素分析 ,去除混杂因素影响后 ,仍然显示对LN肾功能不全的肾功能恢复有影响的因素包括 :环磷酰胺 (CTX)治疗 ,性别 ,肾功能不全的病程 ,肾脏大小 ,贫血和血肌酐值。其中CTX治疗可促进肾功能恢复 ,每周剂量≤ 0 2 5 g/m2 时肾功能恢复的危险比 (HR)为 4 41,95 %的可信区间 (CI)为 (1 0 3 ,18 94) ,每周剂量 >0 2 5 g/m2 时的HR为 13 2 9,95 %CI为 (3 11,5 6 82 )。男性HR为 0 5 1,95 %CI为 (0 2 7,0 95 ) ;肾功能不全的病程(月 )的HR为 0 6 8,95 %CI为 (0 5 3,0 87) ;?
Objective To investigate the factors related to the reversibility of renal function in patients with lupus nephritis (LN) with renal insufficiency. Methods A retrospective cohort study was conducted on 173 patients with LN renal insufficiency admitted from 1991 to 1999 for 6 months. Outcome factors: serum creatinine in azotemia patients decreased to 116 μmol / L or less, serum creatinine in uremia patients decreased by more than 50%, and more than 3 months after dialysis was positive, death could not be restored due to its renal function , So the censoring time is 28 weeks. The study included 51 variables including gender, age, course of disease, symptoms, complications, lupus activity index, various routine, biochemical and immunological tests, and medication. Statistical Methods: The COX proportional hazards regression model analysis. Results 142 cases (82 1%) were followed up. Ninety-three (65.0%) had renal function recovery (positive outcome) and 17 (120%) died. In multivariate analysis using COX regression, factors that affected the renal function recovery of LN renal insufficiency after removal of confounding factors were also shown: cyclophosphamide (CTX) treatment, gender, duration of renal insufficiency, kidney size , Anemia and serum creatinine values. Among them, the CTX treatment can promote the recovery of renal function, and the hazard ratio (HR) of renal function recovery when the dose of 0 25 g / m2 is 41 41%, 95% confidence interval (CI) ), HR was 13 2 9 and 95% CI was (3 11,5 6 82) at weekly doses> 0 2 5 g / m 2. The HR for males was 0 5 and the 95% CI was (0 2 7,0 95). The HR for the duration of renal insufficiency (months) was 0 6 8, and the 95% CI was (0 53,087).