| Objective: Systemic lupus erythematosus(SLE)is a chronic autoimmune disease characterized by multiple autoantibodies and multiple organ system damage caused by multiple factors.Lupus nephritis(LN)is the most frequently involved organ in SLE,and also one of the severely damaged target organs in SLE.The current treatment remission rate of LN is not ideal,which affects the quality of life and long-term survival rate of patients.Through the retrospective collection and collation of the clinical,pathological,treatment and follow-up data of LN patients in our hospital,objective analysis and summary of the characteristics and efficacy differences of different treatment schemes are made,hoping to provide reference value for the follow-up related clinical research and practice.Methods: This study collected and statistically analyzed the general demographic characteristics,clinical manifestations,renal pathological classification,immunological indicators,laboratory test results,treatment plans and treatment status of patients with SLE who were hospitalized in our hospital from January 2018 to December 2021 and were diagnosed as LN by pathological biopsy and followed up for more than 1 year,Describe and analyze the difference of efficacy and safety of different treatment schemes on LN before treatment and at different follow-up time points.Results: Through the medical record system,a total of 162 patients with SLE and LN diagnosed by pathology during the period from January 2018 to December 2021 were found in the center.After excluding patients who were followed up for less than one year,98 patients were finally included.According to the different treatment drugs,they were divided into three groups: 53 patients in the traditional treatment group,32 patients in the multi-target group,and 13 patients in the biological agent group.The TPU(mg/24h),e GFRm L/(min*1.73m^2)and serum creatinine of three different treatment groups at different time points(initial diagnosis,follow-up 3 months,6months,12 months)were measured by repeated measurement analysis of variance(μmol/L),serum albumin(g/L),complement C3(g/L),complement C4(g/L),Ig G(g/L),anti-C1 q antibody and anti-ds-DNA antibody.The results showed that the TPU,serum albumin,complement C3,complement C4,Ig G,anti-C1 q antibody and anti-ds-DNA antibody in the traditional treatment group,multi-target group and biological preparation group were not statistically significant except at different time points;The e GFR results of the three groups showed that there was no statistical significance between different time points and interactions except among different groups;The creatinine results of the three groups showed that there was no statistical significance at different time points,between groups and interactions.The results of the three groups at 3,6 and 12 months of follow-up showed that the complete response rate(34.4%)of the multi-target group after 3 months of treatment was significantly higher than that of the traditional treatment group(22.6%)and the biological preparation group(23.1%),and the complete response rate of the multi-target group(62.5%)after 6 months of treatment was higher than that of the biological preparation group(61.5%),which was higher than that of the traditional treatment group(58.5%),The complete remission rate in the biological preparation group(69.2%)was higher than that in the multi-target group(53.1%)and higher than that in the traditional treatment group(47.2%)after 12 months of treatment.There was no significant difference in the partial response rate,complete response rate and overall response rate among the three groups at each time point(P>0.05).According to the situation of proteinuria reduction in different treatment groups,the rate of reaching the treatment target at 12 months of follow-up: 9 out of 13 people in the biological preparation group(69.2%)reached the standard,17 out of 32 people in the multi-target group(53.1%)reached the standard,25 out of 53 people in the traditional treatment group(47.2%)reached the standard.However,there was no significant difference in the rate of reaching the standard at 3,6 and 12 months among the three groups(P>0.05).Among the 32 patients in the multi-target group,15 patients were non-remission patients who had received traditional treatment in the past.After changing the multi-target regimen,26.7% of the patients achieved complete remission after 6months of treatment,53.3% of the patients achieved complete remission after 12 months of treatment.The multi-target therapy as a remedial treatment improved the remission rate of refractory LN patients.The comparison results of adverse events among the three groups showed that the incidence of adverse events in the traditional treatment group was higher than that in the multi-target group and the biological preparation group as a whole.The incidence of infection in the traditional treatment group was significantly higher than that in the other two groups(P=0.083).The incidence of leukopenia in the biological preparation group was higher than that in the traditional treatment group than that in the multi-target group(P=0.084).Within one year of follow-up,2 patients in the traditional treatment group reached ESRD,and the kidney survival rate was 96.2%,No one in the multi-target group and biological preparation group reached ESRD,and the renal survival rate was 100%,with no significant difference(P=0.643)。Conclusion: 1.One-year treatment observation of LN patients: the complete remission rate reached the peak in the traditional treatment group and the multi-target group after 6 months of treatment,while the complete remission rate in the biological preparation group still improved further after 12 months.2.The rate of reaching the treatment target at the follow-up of 12 months: biological preparation group>multi-target group>traditional treatment group.3.Multi-target therapy as a remedial treatment improves the remission rate of refractory LN patients.4.The multi-target group and biological preparation group can maintain the stability of renal function,and 2 patients in the traditional treatment group entered ESRD. |
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