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Abstract：
There have been only several studies on the correlation between glomerular exostosin expression and membranous lupus nephritis. In this study, we validate the previous findings in Chinese patients with class 5 lupus nephritis.
One hundred sixty-five patients with class 5 lupus nephritis and varying numbers of control patients were included. Exostosin1/exostosin2 staining was performed by immunohistochemistry, and the staining intensity was quantified using an imaging analysis system. Between-group comparisons were tested for statistical significance using the Pearson chi-squared test, the Fisher exact test, the unpaired t test, the Mann-Whitney U test, or one-way ANOVA.
In total, 46% of patients with class 5 lupus nephritis, 9% of patients with class 5 + 3/4 lupus nephritis, and none of the other classes of lupus nephritis were exostosin positive. Only three patients were exostosin positive among the 61 patients with other secondary membranous nephropathy. The exostosin-positive rate in nephrotic patients was significantly higher than that in patients without nephrotic syndrome (P<0.001), and the exostosin staining intensities of the patients with exostosin-positive class 5 were positively correlated with proteinuria (r=0.53; P<0.001). Compared with the patients with exostosin-negative cases, the patients with exostosin-positive cases had higher proteinuria levels (3.9 [interquartile range, 2.0-6.3] g/d versus 2.3 [interquartile range, 1.0-3.6] g/d; P<0.001); lower scores of activity index (1 [interquartile range, 1-2] versus 2 [interquartile range, 1-3]; P=0.001), chronicity index (1 [interquartile range, 0-2] versus 2 [interquartile range, 1-2]; P=0.02), and tubular atrophy score (0 [interquartile range, 0-1] versus 1 [interquartile range, 0-1]; P=0.008); a higher proportion of extensive subepithelial deposition (62% versus 27%; P<0.001); a similar treatment response; and comparable time to kidney end point. Among the 47 patients with class 5 who underwent repeat biopsy, 97% of those with exostosin-negative cases remained negative, whereas 44% of those with exostosin-positive cases were still positive. The rate of histologic transition in the patients with exostosin-negative class 5 was significantly higher than that in the patients with exostosin-positive class 5 (59% versus 22%; P=0.03).
Exostosin positivity occurred frequently in patients with class 5 lupus nephritis, and patients with exostosin-positive cases had more severe proteinuria and a lower rate of histologic transition than the exostosin-negative patients.
One hundred sixty-five patients with class 5 lupus nephritis and varying numbers of control patients were included. Exostosin1/exostosin2 staining was performed by immunohistochemistry, and the staining intensity was quantified using an imaging analysis system. Between-group comparisons were tested for statistical significance using the Pearson chi-squared test, the Fisher exact test, the unpaired t test, the Mann-Whitney U test, or one-way ANOVA.
In total, 46% of patients with class 5 lupus nephritis, 9% of patients with class 5 + 3/4 lupus nephritis, and none of the other classes of lupus nephritis were exostosin positive. Only three patients were exostosin positive among the 61 patients with other secondary membranous nephropathy. The exostosin-positive rate in nephrotic patients was significantly higher than that in patients without nephrotic syndrome (P<0.001), and the exostosin staining intensities of the patients with exostosin-positive class 5 were positively correlated with proteinuria (r=0.53; P<0.001). Compared with the patients with exostosin-negative cases, the patients with exostosin-positive cases had higher proteinuria levels (3.9 [interquartile range, 2.0-6.3] g/d versus 2.3 [interquartile range, 1.0-3.6] g/d; P<0.001); lower scores of activity index (1 [interquartile range, 1-2] versus 2 [interquartile range, 1-3]; P=0.001), chronicity index (1 [interquartile range, 0-2] versus 2 [interquartile range, 1-2]; P=0.02), and tubular atrophy score (0 [interquartile range, 0-1] versus 1 [interquartile range, 0-1]; P=0.008); a higher proportion of extensive subepithelial deposition (62% versus 27%; P<0.001); a similar treatment response; and comparable time to kidney end point. Among the 47 patients with class 5 who underwent repeat biopsy, 97% of those with exostosin-negative cases remained negative, whereas 44% of those with exostosin-positive cases were still positive. The rate of histologic transition in the patients with exostosin-negative class 5 was significantly higher than that in the patients with exostosin-positive class 5 (59% versus 22%; P=0.03).
Exostosin positivity occurred frequently in patients with class 5 lupus nephritis, and patients with exostosin-positive cases had more severe proteinuria and a lower rate of histologic transition than the exostosin-negative patients.
摘要：
关于肾小球外生骨素表达与膜性狼疮性肾炎之间的相关性只有几项研究。在这项研究中,我们在中国5类狼疮性肾炎患者中验证了先前的发现.
纳入了165例5级狼疮性肾炎患者和不同数量的对照患者。通过免疫组织化学进行外泌素1/外泌素2染色，并且使用成像分析系统对染色强度进行定量。组间比较采用皮尔逊卡方检验进行统计学显著性检验,费希尔精确检验,未配对t检验，Mann-WhitneyU测试,或单向方差分析。
总共，46%的患者患有5类狼疮性肾炎，9%的5+3/4级狼疮性肾炎患者，其他类型的狼疮性肾炎均未出现外生骨素阳性。在61例其他继发性膜性肾病患者中，只有3例患者为外生骨素阳性。肾病患者外生骨素阳性率明显高于非肾病综合征患者(P<0.001),外植骨素阳性5类患者的外植骨素染色强度与蛋白尿呈正相关（r=0.53；P<0.001）。与外生骨素阴性患者相比，外植骨素阳性患者的蛋白尿水平较高（3.9[四分位距，2.0-6.3]g/d对2.3[四分位数范围，1.0-3.6]g/d；P<0.001）；活动指数得分较低（1[四分位数间距，1-2]与2[四分位数间距，1-3]；P=0.001），慢性指数(1[四分位距，0-2]对2[四分位数范围，1-2]；P=0.02），和肾小管萎缩评分(0[四分位数间距，0-1]与1[四分位数间距，0-1]；P=0.008）；广泛上皮下沉积的比例更高（62％对27％；P<0.001）；相似的治疗反应；与肾脏终点的时间相当。在接受重复活检的47例5级患者中，97%的外生骨素阴性病例仍然阴性，而44％的外生骨素阳性病例仍为阳性。外植骨素阴性5级患者的组织学转变率显着高于外植骨素阳性5级患者（59％对22％；P=0.03）。
外泌素阳性在5级狼疮性肾炎患者中经常发生，与外生骨素阴性患者相比，外生骨素阳性患者的蛋白尿更严重，组织学转变率更低。
纳入了165例5级狼疮性肾炎患者和不同数量的对照患者。通过免疫组织化学进行外泌素1/外泌素2染色，并且使用成像分析系统对染色强度进行定量。组间比较采用皮尔逊卡方检验进行统计学显著性检验,费希尔精确检验,未配对t检验，Mann-WhitneyU测试,或单向方差分析。
总共，46%的患者患有5类狼疮性肾炎，9%的5+3/4级狼疮性肾炎患者，其他类型的狼疮性肾炎均未出现外生骨素阳性。在61例其他继发性膜性肾病患者中，只有3例患者为外生骨素阳性。肾病患者外生骨素阳性率明显高于非肾病综合征患者(P<0.001),外植骨素阳性5类患者的外植骨素染色强度与蛋白尿呈正相关（r=0.53；P<0.001）。与外生骨素阴性患者相比，外植骨素阳性患者的蛋白尿水平较高（3.9[四分位距，2.0-6.3]g/d对2.3[四分位数范围，1.0-3.6]g/d；P<0.001）；活动指数得分较低（1[四分位数间距，1-2]与2[四分位数间距，1-3]；P=0.001），慢性指数(1[四分位距，0-2]对2[四分位数范围，1-2]；P=0.02），和肾小管萎缩评分(0[四分位数间距，0-1]与1[四分位数间距，0-1]；P=0.008）；广泛上皮下沉积的比例更高（62％对27％；P<0.001）；相似的治疗反应；与肾脏终点的时间相当。在接受重复活检的47例5级患者中，97%的外生骨素阴性病例仍然阴性，而44％的外生骨素阳性病例仍为阳性。外植骨素阴性5级患者的组织学转变率显着高于外植骨素阳性5级患者（59％对22％；P=0.03）。
外泌素阳性在5级狼疮性肾炎患者中经常发生，与外生骨素阴性患者相比，外生骨素阳性患者的蛋白尿更严重，组织学转变率更低。
