背景:原发性干燥综合征(pSS)是一种常见的慢性系统性自身免疫性疾病,主要影响外分泌腺。患者可能患有累及多个器官的腺外疾病,包括肾脏.本研究旨在调查与肾功能损害或肾脏受累相关的临床数据和实验室标志物。
方法:这项回顾性队列研究纳入了来自风湿病学和临床免疫学系的一千二百88例成人pSS患者。其中有334名患者进行了两年多的人口统计学分析,临床数据和实验室标志物。通过R软件(版本3.6.2)进行统计学分析。
结果:1288名pSS患者中,近95%为女性,抗SSA(干燥综合征A)和抗SSB的阳性率分别为63%和27%。12%的pSS患者出现肾脏受累,eGFR<60mL/min/1.73m2,平均住院年龄,血肌酐和尿素最高(P<0.001),ANA(抗核抗体)阳性,抗SSB阳性和抗scl-70阳性在该组中更为普遍.多变量分析表明,年龄,尿素,氯和抗SSA表明与肾功能障碍显著相关。钾,钠和Jo-1也被证实与肾功能下降有关。包括上述因素的受试者工作特性(ROC)分析在评估肾损伤方面具有良好的性能,包括eGFR<60mL/min/1.73m2和eGFR60-90mL/min/1.73m2。曲线下面积(AUC)值为0.957和0.821,灵敏度高(71.1%和84.4%)和特异性高(95.5%和70.5%)。抗SSA阳性患者经过两年多的随访,34.14%的患者出现肾功能下降,其中13.58%的患者出现肾损伤进展,eGFR下降23.64%.
结论:年龄,尿素,氯,抗SSA与pSS肾损伤高度相关。早期筛查自身抗体对评估和预防pSS肾损伤具有重要意义。
BACKGROUND: Primary Sjögren\'s syndrome (pSS) is a common chronic systemic autoimmune disorder which primarily affects the exocrine glands. Patients may have extraglandular disease involving multiple organs, including the kidneys. This study aimed at investigating the clinical data and laboratory markers which were associated with renal function damage or renal involvement.
METHODS: One thousand two hundred eighty-eight adult pSS patients from the Department of Rheumatology and Clinical Immunology were enrolled in this retrospective cohort study. And there were 334 patients of them followed up for more than two years for analyzing demographic, clinical data and laboratory markers. Statistical analysis was performed by R software (Version 3.6.2).
RESULTS: Nearly 95% of 1288 pSS patients were women, and the positive rates of anti-SSA (Sjögren\'s syndrome A) and anti-SSB were 63% and 27% respectively. 12% of the pSS patients presented renal involvement with eGFR < 60 mL/min/1.73 m2, and the mean age of hospital presentation, serum creatinine and urea were the highest (P < 0.001), and ANA (antinuclear antibody)-positive, anti-SSB-positive and anti-scl-70-positive were more prevalent in this group. Multivariate analyses showed that age, urea, chlorine and anti-SSA indicate a significant association with renal dysfunction. Potassium, sodium and Jo-1 were also confirmed to be related with decreased renal function. The receiver operating characteristic (ROC) analysis including the above factors showed a good performance on the evaluation of renal injury including eGFR < 60 mL/min/1.73 m2 and eGFR 60 -90 mL/min/1.73 m2 in pSS, with area under curve (AUC) values of 0.957 and 0.821, and high sensitivity (71.1% and 84.4%) and specificity (95.5% and 70.5%). After a more than two years follow-up of anti-SSA positive patients, 34.14% of them developed decreased renal function, and 13.58% of them experienced a progression of renal injury with a 23.64% decrease in eGFR.
CONCLUSIONS: Age, urea, chlorine, and anti-SSA were highly associated with renal injury in pSS. Early screening for autoantibodies would be meaningful for evaluation and prevention of renal injury in pSS.