lupus podocytopathy

狼疮足细胞病
  • 文章类型: Journal Article
    狼疮足细胞病是一种新认识的狼疮性肾炎,其特征是广泛的肾小球足突消退,没有毛细血管壁免疫沉积。有或没有其他免疫抑制剂的糖皮质激素的治疗反应和复发尚未得到很好的研究。在这项研究中,纳入50例狼疮足细胞病患者,并接受糖皮质激素单独治疗(糖皮质激素单一疗法)或糖皮质激素加其他免疫抑制剂(联合疗法)的诱导或维持治疗方案。分别分析两组患者的治疗反应和复发率。我们发现,糖皮质激素单一疗法和联合疗法的诱导治疗导致47例患者(94.0%)在12周的治疗中缓解,38例(76.0%)患者完全缓解(CR)。糖皮质激素单药治疗和联合治疗的CR率无差异(76.7%vs75.0%,p=0.9),糖皮质激素单药治疗的中位CR时间为4周(范围:2.0~6.0周),联合治疗的中位CR时间为8.0周(范围:3.7~12.0周)(p=0.076).47例患者中有27例(57.4%)在维持期间复发,糖皮质激素单药治疗组的复发率远高于联合治疗组(89.5%vs35.7%,p<0.001),无论诱导方案是糖皮质激素单一疗法还是联合疗法。随访6-125个月(中位数为62个月),无患者出现终末期肾病或死亡。总之,狼疮足细胞病的缓解可以通过糖皮质激素单一疗法或糖皮质激素联合其他免疫抑制剂来诱导,而缓解应通过联合方案维持。
    Lupus podocytopathy is a newly recognized class of lupus nephritis characterized by extensive glomerular foot process effacement without capillary wall immune deposits. The treatment response and relapse of glucocorticoid with or without additional immunosuppressive agents has not been well investigated. In this study, 50 patients with lupus podocytopathy were included and received glucocorticoid alone (glucocorticoid monotherapy) or glucocorticoid plus additional immunosuppressive agents (combination therapy) for their induction or maintenance treatment regimens. The treatment response and relapse rate in the two groups were respectively analyzed. We found that the induction treatment with glucocorticoid monotherapy and combination therapy led to remission in 47 patients (94.0%) at 12 weeks treatment, with complete remission (CR) occurring in 38 patients (76.0%). The CR rate compared between glucocorticoid monotherapy and combination therapy showed no difference (76.7% vs 75.0%, p = 0.9), the median time to CR was four weeks (range: 2.0-6.0 weeks) in glucocorticoid monotherapy and 8.0 weeks (range: 3.7-12.0 weeks) in combination therapy (p = 0.076). Twenty-seven of 47 patients (57.4%) relapsed during maintenance, the relapse rate was much higher in the glucocorticoid monotherapy group than in the combination therapy group (89.5% vs 35.7%, p < 0.001), regardless of the induction regimens being glucocorticoid monotherapy or combination therapy. No patient developed end stage renal disease or died during follow-up for 6-125 months (median 62 months). In conclusion, the remission of lupus podocytopathy could be induced by glucocorticoid monotherapy or glucocorticoid plus other immunosuppressive agents, while the remission should be maintained by the combination regimen.
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