背景:狼疮性肾炎(LN)表现为系统性红斑狼疮(SLE),其特征在于各种临床和实验室特征。本研究旨在根据LN诊断时间综合评价LN患者的特点:早发性(LN诊断为SLE一年内)与延迟发作(LN诊断为SLE诊断后一年以上)。
方法:我们对克拉科夫大学医院接受治疗的所有SLE患者的病历进行了回顾性分析,波兰,从2012年到2022年。我们收集了人口统计数据,临床,和实验室特点,包括组织学发现,治疗方式,和疾病结果。进行统计分析以确定影响LN发展和预后的因素。
结果:在331名LN患者中,207例(62.54%)诊断为早发性,122例(36.86%)记录为迟发性.在2例(0.6%)LN病例中,SLE病程中首次出现肾脏表现的时间未知.在SLE诊断时,延迟发作LN的男女比例较高,年龄较小。该组与更严重的临床表现相关。反过来,研究的亚组在内科医生合并症方面没有差异,肾脏组织病理学,以及自身免疫性疾病的家族史。延迟发作的LN表现出更高的抗dsDNA频率,反史密斯,反Ro,反RNP,和抗心磷脂IgG自身抗体。在14年的随访期间,16例患者死亡。在两个分析的亚组中,死亡率和死亡原因具有可比性。
结论:延迟发作的LN的更严重的临床表现促使严格监测非LNSLE患者以早期诊断和治疗肾脏受累。此外,认识到自身抗体如抗dsDNA或抗Smith在延迟发作LN中的较高频率强调了自身抗体谱分析作为诊断和预后工具的潜在价值.
BACKGROUND: Lupus nephritis (LN) manifests systemic lupus erythematosus (SLE) and is characterized by various clinical and laboratory features. This study aimed to comprehensively evaluate the characteristics of LN patients according to the time of LN diagnosis: early-onset (LN diagnosed within one year from SLE diagnosis) vs. delayed-onset (LN diagnosed more than one year after SLE diagnosis).
METHODS: We conducted a retrospective analysis of medical records from all SLE patients treated at the University Hospital in Kraków, Poland, from 2012 to 2022. We collected data on demographic, clinical, and laboratory characteristics, including histological findings, treatment modalities, and disease outcomes. Statistical analyses were performed to identify factors impacting LN development and prognosis.
RESULTS: Among 331 LN patients, early-onset was diagnosed in 207 (62.54%) and delayed-onset was documented in 122 cases (36.86%). In 2 (0.6%) LN cases, the time of first kidney manifestation in the SLE course was unknown. Delayed-onset LN had a higher female-to-male ratio and younger age at SLE diagnosis. This group was associated with more severe clinical manifestations. In turn, studied subgroups did not differ in internist comorbidities, kidney histopathology, and family history regarding autoimmune diseases. Delayed-onset LN exhibited a higher frequency of anti-dsDNA, anti-Smith, anti-Ro, anti-RNP, and anti-cardiolipin IgG autoantibodies. During a 14-year follow-up period, 16 patients died. Mortality rate and causes of death were comparable in both analyzed subgroups.
CONCLUSIONS: More severe clinical manifestations in delayed-onset LN prompt strict monitoring of non-LN SLE patients to diagnose and treat kidney involvement early. Also, recognizing the higher frequency of autoantibodies such as anti-dsDNA or anti-Smith in delayed-onset LN underscores the potential value of autoantibody profiling as a diagnostic and prognostic tool.