摘要:介紹：因為係統性紅斑狼瘡和狼瘡性腎炎在男性中的少見性，對其的理解也較缺乏。我們的目的在於分析既往史明確診斷的男性係統性紅斑狼瘡和狼瘡性腎炎的臨床表現及病因，並分析疾病進展至腎病終末期的危險因素。方法學：對55位來自西班牙和烏拉圭的曆史隊列研究中的患者進行回顧性分析，並與一組年齡及疾病特點匹配的女性患者隊列進行對比分析。結果：腎髒活檢的中位年齡是27歲(區間：8-79歲)。主要臨床表現形式是腎病綜合征(50位患者中有26位，占52%)和Ⅳ型狼瘡性腎炎(50位患者中有34位，占68%)。經過治療，21位患者(45.6%)獲得完全腎髒緩解。在隨訪期間，12位患者需要腎髒替代治療，3位患者死於感染相關疾病。當對需要腎髒替代治療治療患者及不需要替代的患者的腎髒活檢時期指標進行對比分析時，以下幾項參數有統計學差異(P<0.05)：估算的腎小球濾過率<60ml/min，高血壓，低白蛋白血症，相伴隨的其他髒器受累(神經係統，心血管和或肺髒)。在多變量分析中，僅估算的腎小球濾過率<60ml/min這一項仍為疾病進展至腎病終末期的危險因素。當與女性狼瘡性腎炎患者的隊列進行對比分析時，緩解或腎髒保存的指標均無顯著性差異。討論：男性狼瘡性腎炎常表現為腎病綜合征，Ⅳ型狼瘡性腎炎是最常見病理表型。進行腎髒活檢時的估算的腎小球濾過率<60ml/min與腎髒不良預後相關。在對比男性和女性狼瘡性腎炎患者隊列時，狼瘡性腎炎的緩解或進展並無顯著性差異。
附原文：
Abstract INTRODUCTION:Becauseof their rarity in men, systemiclupuserythematous andlupusnephritis(LN) are poorly understood in men. Our aim was to analyze theclinical presentation and course of histology-provenystemiclupuserythematous and LN inmalesand to determinethe risk factors for progression to end-stage renal disease. METHODS:Fiftypatients from 2 historical cohorts in Spain (Hospital 12 de Octubre) andUruguay were retrospectively analyzed and compared with a female cohort matchedfor age and disease characteristics.RESULTS:The median age at the time of renalbiopsy was 27 years (range, 8-79 years). The main forms of presentation werenephrotic syndrome in 26 of 50 patients (52%), and class IV LN in 34 of 50(68%). After treatment, 21 patients (45.6%) achieved complete renal remission.During follow-up, 12 patients required renal replacement therapy, and 3patients died of infectious causes. When patients who required renalreplacement therapy were compared with those who did not require it, severalparameters showed significant differences (P< 0.05) at the timeof renal biopsy: estimated glomerular filtration rate< 60 ml/min,hypertension, hypoalbuminemia, and concomitant visceral involvement(neurologic, cardiovascular, and/or pulmonary). In the multivariate analysis,only estimated glomerular filtration rate< 60 ml/min persisted as arisk factor for progression to end-stage renal disease. When compared with acohort of female patients with LN, there were no significant differences inremission or renal survival.DISCUSSION:LN inmalesusually presents as nephroticsyndrome, and type IV LN is the most frequent form. An estimated glomerularfiltration rate< 60 ml/min at the time of renal biopsy is associatedwith poor renal outcomes. There were no differences in remission or progressionof LN inmaleswhen compared with a cohort of female patients withLN.
引自：Urrestarazú A,Otatti G,SilvariñoR,et al. LupusNephritisinMales: Clinical Features, Course, and Prognostic Factorsfor End-Stage Renal Disease.Kidney Int Rep.2017 Jun16;2(5):905-912. doi: 10.1016/j.ekir.2017.05.011. eCollection 2017 Sep.
