目的 分析儿童Ⅲ~Ⅴ型无症状性狼疮性肾炎（silent lupus nephritis, SLN）的危险因素及预后特征。 方法 回顾性收集2007年5月—2023年4月于中南大学湘雅二医院儿科确诊的30例SLN患儿的临床资料，根据肾脏病理分型分为Ⅱ型组（12例）和Ⅲ~Ⅴ型组（18例），分析Ⅲ~Ⅴ型SLN发生的危险因素，并总结其预后特征。 结果 30例SLN患儿，中位随访时长61.50个月，Ⅱ型组和Ⅲ~Ⅴ型组患儿停用糖皮质激素比例、达到用药狼疮低疾病活动状态比例、估算肾小球滤过率年下降速度比较差异均无统计学意义（P>0.05）；Ⅱ型组有3例患儿达到慢性肾脏病（chronic kidney disease, CKD）1期，Ⅲ~Ⅴ型组有8例达到CKD 1期，4例达到CKD 2期。26例女性SLN患儿中，Ⅲ~Ⅴ型组血清补体C3水平低于Ⅱ型组（P<0.05）。SLN患儿、女性SLN患儿血清C3水平与肾脏中IgA、IgG和C3免疫复合物荧光强度呈负相关（P<0.05），女性SLN患儿血清C3水平还与肾脏病理活动性指数呈负相关（P<0.05）。二元logistic回归分析提示，女性和低血清补体C3水平是儿童Ⅲ~Ⅴ型SLN发生的危险因素（P<0.05）。 结论 SLN患儿中Ⅲ~Ⅴ型并不少见，远期仍有肾功能进展的风险，女性和低血清补体C3水平是儿童Ⅲ~Ⅴ型SLN的危险因素。
Abstract
Objective To study the risk factors and prognostic characteristics of pediatric silent lupus nephritis (SLN) with class Ⅲ to V. Methods A retrospective study was conducted to collect clinical data from 30 children diagnosed with SLN at the Department of Pediatrics, Second Xiangya Hospital, Central South University, from May 2007 to April 2023. Based on renal pathological classification, the patients were divided into a class Ⅱ group (12 cases) and a class Ⅲ to Ⅴ group (18 cases). The risk factors for the occurrence of class Ⅲ to Ⅴ SLN were analyzed, and the prognostic characteristics were summarized. Results Among the 30 SLN patients, the median follow-up time was 61.50 months. There were no statistically significant differences in the proportions of patients who discontinued glucocorticoids or achieved low disease activity status, nor in the annual decline rate of estimated glomerular filtration rate (eGFR) between the class Ⅱ and class Ⅲ to V groups (P>0.05). However, three patients in the class Ⅱ group progressed to stage 1 chronic kidney disease (CKD), while eight patients in the class III to V group reached stage 1 CKD, and four patients reached stage 2 CKD. Among the 26 female SLN patients, serum complement C3 levels in the class III to V group were lower than those in the class Ⅱ group (P<0.05). Serum C3 levels in SLN patients, as well as in female SLN patients, were negatively correlated with the fluorescence intensity of IgA, IgG, and C3 immune complexes in the kidneys (P<0.05). Additionally, serum C3 levels in female SLN patients were negatively correlated with the renal pathological activity index (P<0.05). Binary logistic regression analysis indicated that being female and having low serum complement C3 levels were risk factors for the occurrence of class Ⅲ to V SLN in children (P<0.05). Conclusions Class Ⅲ to V SLN is not uncommon among SLN children, and there remains a risk of long-term renal function progression. Being female and having low serum complement C3 levels are identified as risk factors for class Ⅲ to V SLN in children.
关键词
无症状性狼疮性肾炎 /
补体C3 /
危险因素 /
预后 /
儿童
Key words
Silent lupus nephritis /
Complement C3 /
Risk factor /
Prognosis /
Child
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参考文献
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基金
国家重点研发计划（2021YFC2702004）；国家自然科学基金青年项目（82101905）。
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