| ObjectiveTo investigate and analyze the clinicopathologic features,different t herapeutic strategies and efficacy of lupus nephritis,as well as evaluating the risk factors of renal prognosis.MethodsMedical records of patients diagnosed with lupus nephritis in Nanfang Hospital of Southern Medical University from January 2017 to December 2021 were collected.We analyzed the clinicopathological features,therapeutic efficacy,medical costs,readmission rates and causes of different therapeutic strategies.Logistic regression was used to analyze factors associated with clinical remission during induction therapy,and Cox regression analysis was used to determine risk factors for renal prognosis.ResultsA total of 239 patients were included in this study,with a median age of 30 years,among which 186 were female(77.8%).Among the pathological types,type Ⅳ(84 cases,35%)and type Ⅴ+Ⅳ(77 cases,32%)were the most common.During induction therapy,all patients received glucocorticoids,92.9%received immunosuppressant therapy,and the most commonly used immunosuppressant drugs were cyclophosphamide(33.5%)and Mycophenolate mofetil(36.0%),followed by Tacrolimus/cyclosporine(10.9%),multi-target regimen(10.0%),mycophenolate mofetil combined with Belimumab(2.5%),and glucocorticoid therapy alone(7.1%).The complete response rates were 42.5%,33.7%,26.9%,8.3%,66.7%and 47.1%,and the total response rates were 83.8%,76.7%,69.2%,62.5%,100%and 88.3%,respectively.The readmission rate during induction therapy was 26.4%,the main reasons were pulmonary infection(13.0%)and severe edema(8.4%).The treatment regimen with the highest per capita medical cost was myfehenolate mofetil combined with Belimumab group(78,505 yuan),followed by cyclophosphamide group(37,700 yuan),multi-target group(35,444 yuan),myfehenolate mofetil group(25,755 yuan),tacrolimus/cyclosporine group(23,809 yuan)and glucocorticoid alone group(14,739 yuan).Logistic regression analysis shows:Gender(OR=0.412,95%CI 0.189-0.898,P=0.026),baseline creatinine(OR=0.996,95%CI 0.992-0.999,P=0.006),and albumin levels(OR=1.164,95%CI 1.094-1.239,P=<0.001)were an independent factor for clinical remission during induction therapy.LN patients were followed up to 24 monthsv.Maintenance therapy regimens were glucocorticoid combined with cyclophosphamide(13%),mycophenolate mofetil(49%),tachlimus/cyclosporine(12%),multi-target(6%),and glucocorticoid alone(20%).At 24 months,the complete response rates were 84.6%,89.8%,66.7%,33.3%and 65.0%,respectively.A total of 15 patients(15%)relapsed maintenance treatment,and there was no significant difference in recurrence rate between different treatment groups,The main pathological types were type Ⅳ(5 patients,33.3%)and type Ⅴ+Ⅳ(6 patients,40.0%).Multi-factor COX regression analysis shows that men[HR 2.016(1.003-4.052),P=0.049],lower glomerular filtration rate at baseline[HR 0.962(0.945-0.979),P<0.001],and no response after 6 months of induction therapy[HR 2.075(1.0154.244),P=0.046]were associated with renal prognosis.ConclusionIn this study,lupus nephritis patients had a relatively high response rate during induction therapy,the efficacy and medical costs of different treatment regimens were different.Gender,baseline creatinine and albumin levels were independent determinants of clinical remission during induction therapy.Males,lower baseline glomerular filtration rate,and no response after 6 months of induction therapy were associated with renal prognosis.With the emergence of new treatment methods,clinicians need to consider the balance between benefits and risks and make judgments based on factors related to efficacy and safety,potential adverse reactions,medical costs,quality of life,and compliance with patients. |
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